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Acute Kidney Injury After Heart Transplant in Children; Risk Factors and Outcomes Open Access


Other title
Type of item
Degree grantor
University of Alberta
Author or creator
MacDonald, Christine, L
Supervisor and department
Colleen Norris (Faculty of Nursing)
Examining committee member and department
Gwen Alton (Alberta Health Services)
Ari Joffe (Department of Medicine)
Catherine Morgan (Department of Medicine)
Simon Urschel (Department of Medicine)
Shannon Scott (Faculty of Nursing)
Gwen Rempel (Faculty of Nursing)
Faculty of Nursing

Date accepted
Graduation date
Master of Nursing
Degree level
Background: Heart transplant is life-saving for children with end-stage congenital heart disease or acquired heart failure. Critical illness following transplantation can include acute kidney injury (AKI). There is little data on the epidemiology of, risk factors for, or impact on outcomes of AKI after pediatric heart transplant. Methods: Using secondary analysis of data from an ongoing prospective cohort study, we evaluated 72 children (0- 5 yrs) who had a heart transplant between 2001 and 2012. We evaluated: 1) postoperative AKI rate (defined by pRIFLE); 2) pre-, intra-, and early postoperative AKI risk factors (days on waitlist, inotrope use and ventilation pre-transplant, ECMO / ventricular assist device at transplant, preoperative estimated glomerular filtration rate (eGFR), ABO incompatibility, donor ischemic time, peak intraoperative lactate, tacrolimus level early postoperatively) using stepwise logistic regression; 3) effect of AKI on short-term outcomes (duration of ventilation and length of PICU stay). Results: AKI occurred in 73% of children. Independent predictors of AKI were pre-transplant ventilation (OR 8.6, p=0.007) and higher eGFR (p=0.032). Following adjustment, preoperative inotrope significantly reduced the risk of AKI (OR 0.13, p=0.016). Sixteen percent of children had a tacrolimus level >15 ug/L on day 3 post-transplant and these children had more AKI than children without (OR 7.8, p=0.086). Although not statistically significant, automated model selection retained tacrolimus level >15 ug/L as a predictor (using multiple different modeling strategies). AKI resulted in longer ventilation days and ICU stay (p=0.038 & p=0.004, respectively). Conclusion: AKI was common after heart transplant and was associated with important outcomes. As in other pediatric cardiac surgery populations, lower preoperative GFR was protective against postoperative AKI; the role of modified immune suppressive strategies in this context needs to be further evaluated. Although not statistically significant, elevated early postoperative tacrolimus is likely biologically important in the prediction of AKI risk and needs further evaluation in a larger cohort.
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