Risk Factors for Chronic Kidney Disease in Pediatric Non-Renal Solid Organ Transplant Recipients.

Abstract

Background: Chronic kidney disease (CKD) is a significant cause of morbidity and mortality in non-renal solid organ transplant (NRSOT; liver, heart, lung, and multiple organs) recipients. Risk factors associated with incident CKD after pediatric NRSOT remain uncertain. Objective:Determine risk factors associated with CKD development among childhood recipients of non-renal NRSOTs. Methods: The study cohort included 344 children who received their first NRSOT between January 1st, 2002 and January 1st, 2012 at the Hospital for Sick Children and were followed until the time of transfer (at age of 18 years) or death. CKD was defined as two consecutive estimated glomerular filtration rates (eGFR) of < 60 ml/min/1.73m2 over 2 months using the modified Schwartz formula. Cox regression model was used to examine the risk factors of age, gender, organ type, eGFR at transplant, use of induction medication, and angiotensin converting enzyme inhibitors used in year 1 post-transplant. Results: The population included liver (48%), heart (41%), lung (8%), and multiple organ (3%) transplant recipients. During a mean follow-up of 4.2 years (median: 3.9 years), 63 (18%) recipients developed CKD. The relative hazard for CKD was 3.78 higher in lung, 2.08 in heart, and 1.67 in multi-organ transplant compared to liver recipients (Table 1). For every 1 mL/min/1.73m2 increase in eGFR at the time of transplant, the hazard ratio for CKD decreased by 3%. Another significant risk factor for CKD was induction medication use.Table: No Caption available.Conclusion: CKD is common among children after NRSOT. The highest risk was observed among recipients of lung and heart, while the lowest risk was seen in liver recipients. Early implementation of strategies to maximize preservation of renal function in pediatric NRSOT population is warranted. DISCLOSURES:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme.