Subsequent kidney transplant after pediatric heart transplant: Prevalence and risk factors

Lucas D G Barrett; Kelli K Ryckman; Amber M Goedken; Emily J Steinbach; Ellen van der Plas; Gary Beasley; Rabia S Khan; Vernat Exil; David A Axelrod; Lyndsay A Harshman

doi:10.1016/j.ajt.2024.02.027

Subsequent kidney transplant after pediatric heart transplant: Prevalence and risk factors

Am J Transplant. 2024 Feb 29:S1600-6135(24)00169-2. doi: 10.1016/j.ajt.2024.02.027. Online ahead of print.

Authors

Affiliations

¹ Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA; University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
² Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA; Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA.
³ University of Iowa College of Pharmacy, Iowa City, Iowa, USA.
⁴ University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
⁵ Psychiatry Department, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; Department of Hematology/Oncology, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
⁶ University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of California, Los Angeles Health Sciences, Los Angeles, California, USA.
⁷ Division of Pediatrics, Cardiology, Saint Louis University, St. Louis, Missouri, USA.
⁸ Department of Surgery, University of Iowa, Iowa City, Iowa, USA.
⁹ University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA. Electronic address: lyndsay-harshman@uiowa.edu.

PMID: 38431077
DOI: 10.1016/j.ajt.2024.02.027

Abstract

Pediatric heart failure and transplantation carry associated risks for kidney failure and potential need for kidney transplant following pediatric heart transplantation (KT/pHT). This retrospective, United Network of Organ Sharing study of 10,030 pediatric heart transplants (pHTs) from 1987 to 2020 aimed to determine the incidence of waitlisting for and completion of KT/pHT, risk factors for KT/pHT, and risk factors for nonreceipt of a KT/pHT. Among pHT recipients, 3.4% were waitlisted for KT/pHT (median time of 14 years after pHT). Among those waitlisted, 70% received a KT/pHT, and 18% died on the waitlist at a median time of 0.8 years from KT/pHT waitlisting (median age of 20 years). Moderate-high sensitization at KT/pHT waitlisting (calculated panel reactive antibody, ≥ 20%) was associated with a lower likelihood of KT/pHT (adjusted hazard ratio, 0.67; 95% confidence interval, 0.47-0.95). Waitlisting for heart transplantation simultaneously with kidney transplant (adjusted hazard ratio, 3.73; 95% confidence interval, 2.01-6.92) was associated with increased risk of death on the KT/pHT waitlist. While the prevalence of KT/pHT is low, there is substantial mortality among those waitlisted for KT/pHT. These findings suggest a need to consider novel risk factors for nonreceipt of KT/pHT and death on the waitlist in prioritizing criteria/guidelines for simultaneous heart-kidney transplantation.

Keywords: epidemiology; kidney transplant; pediatric heart transplant.