Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant

Abstract

The use of ventricular assist devices (VADs) in children with heart failure may be of particular benefit to those with accompanying renal failure, as improved renal function is seen in some, but not all recipients. We hypothesized that persistent renal dysfunction at 7days and/or 1month after VAD implantation would predict chronic kidney disease (CKD) 1year after heart transplantation (HT). Linkage analysis of all VAD patients enrolled in both the PEDIMACS and PHTS registries between 2012 and 2016. Persistent acute kidney injury (P-AKI), defined as a serum creatinine ≥1.5× baseline, was assessed at post-implant day 7. Estimated glomerular filtration rate (eGFR) was determined at implant, 30days thereafter, and 12months post-HT. Pre-implant eGFR, eGFR normalization (to ≥90mL/min/1.73m2 ), and P-AKI were used to predict post-HT CKD (eGFR <90mL/min/1.73m2 ). The mean implant eGFR was 85.4±46.5mL/min/1.73m2 . P-AKI was present in 19/188 (10%). Mean eGFR at 1month post-VAD implant was 131.1±62.1mL/min/1.73m2 , significantly increased above baseline (P<0.001). At 1year post-HT (n=133), 60 (45%) had CKD. Lower pre-implant eGFR was associated with post-HT CKD (OR 0.99, CI: 0.97-0.99, P=0.005); P-AKI was not (OR 0.96, CI: 0.3-3.0, P=0.9). Failure to normalize renal function 30days after implant was highly associated with CKD at 1year post-transplant (OR 12.5, CI 2.8-55, P=0.003). Renal function improves after VAD implantation. Lower pre-implant eGFR and failure to normalize renal function during the support period are risk factors for CKD development after HT.