Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients |
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| Authors: | C. Williams K. Borges T. Banh J. Vasilevska‐Ristovska R. Chanchlani V. L. Ng A. I. Dipchand M. Solomon D. Hebert S. J. Kim B. C. Astor R. S. Parekh |
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| Affiliation: | 1. Department of Medicine, University of Toronto, Toronto, Canada;2. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada;3. Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada;4. Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Canada;5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada;6. Division of Pediatric Gastroenterology Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada;7. Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada;8. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada;9. Division of Pediatric Respiratory Medicine, Hospital for Sick Children, Toronto, Canada;10. Department of Medicine, University Health Network, Toronto, Canada;11. Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI, USA |
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| Abstract: | ![]()
The incidence of acute kidney injury (AKI) and its impact on chronic kidney disease (CKD) following pediatric nonkidney solid organ transplantation is unknown. We aimed to determine the incidence of AKI and CKD and examine their relationship among children who received a heart, lung, liver, or multiorgan transplant at the Hospital for Sick Children between 2002 and 2011. AKI was assessed in the first year posttransplant. Among 303 children, perioperative AKI (within the first week) occurred in 67% of children, and AKI after the first week occurred in 36%, with the highest incidence among lung and multiorgan recipients. Twenty‐three children (8%) developed CKD after a median follow‐up of 3.4 years. Less than 5 children developed end‐stage renal disease, all within 65 days posttransplant. Those with 1 AKI episode by 3 months posttransplant had significantly greater risk for developing CKD after adjusting for age, sex, and estimated glomerular filtration rate at transplant (hazard ratio: 2.77, 95% confidence interval, 1.13‐6.80, P trend = .008). AKI is common in the first year posttransplant and associated with significantly greater risk of developing CKD. Close monitoring for kidney disease may allow for earlier implementation of kidney‐sparing strategies to decrease risk for progression to CKD. |
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| Keywords: | heart transplantation kidney disease kidney failure/injury liver transplantation/hepatology lung transplantation |
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