Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children

Pediatr Nephrol. 2015 Jun;30(6):905-18. doi: 10.1007/s00467-014-2878-4. Epub 2014 Aug 14.

Abstract

Significant advances in cardiac intensive care including extracorporeal life support have enabled children with complex congenital heart disease and end-stage heart failure to be supported while awaiting transplantation. With an increasing number of survivors after heart transplantation in children, the complications from long-term immunosuppression, including renal insufficiency, are becoming more apparent. Severe renal dysfunction after heart transplant is defined by a serum creatinine level >2.5 mg/dL (221 μmol/L), and/or need for dialysis or renal transplant. The degree of renal dysfunction is variable and is progressive over time. About 3-10 % of heart transplant recipients will go on to develop severe renal dysfunction within the first 10 years post-transplantation. Multiple risk factors for chronic kidney disease post-transplant have been identified, which include pre-transplant worsening renal function, recipient demographics and morbidity, peri-transplant haemodynamics and long-term exposure to calcineurin inhibitors. Renal insufficiency increases the risk of post-transplant morbidity and mortality. Hence, screening for renal dysfunction pre-, peri- and post-transplantation is important. Early and timely detection of renal insufficiency may help minimize renal insults, and allow prompt implementation of renoprotective strategies. Close monitoring and pre-emptive management of renal dysfunction is an integral aspect of peri-transplant and subsequent post-transplant long-term care.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / therapy
  • Adolescent
  • Age Factors
  • Calcineurin Inhibitors / adverse effects
  • Child
  • Child, Preschool
  • Disease Progression
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / surgery*
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / surgery*
  • Heart Transplantation / adverse effects*
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Infant
  • Kidney Function Tests
  • Predictive Value of Tests
  • Renal Insufficiency / complications*
  • Renal Insufficiency / diagnosis
  • Renal Insufficiency / physiopathology
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / physiopathology
  • Renal Insufficiency, Chronic / therapy
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • Calcineurin Inhibitors
  • Immunosuppressive Agents