Subsequent Kidney Transplant after Pediatric Heart Transplant: Prevalence and Risk Factors

医学 危险系数 群体反应性抗体 置信区间 内科学 肾移植 心脏移植 肾移植 心力衰竭 移植 入射(几何) 比例危险模型 儿科 物理 光学
作者
Lucas D G Barrett,Kelli K. Ryckman,Amber M. Goedken,Emily J. Steinbach,Ellen van der Plas,Gary S. Beasley,Rabia Khan,Vernat Exil,David A. Axelrod,Lyndsay A. Harshman
出处
期刊:American Journal of Transplantation [Elsevier BV]
标识
DOI:10.1016/j.ajt.2024.02.027
摘要

Pediatric heart failure and transplantation carry associated risks for kidney failure and potential need for kidney transplant following pediatric heart transplantation (KT/pHT). This retrospective, United Network of Organ Sharing study of 10,030 pediatric heart transplants (pHTs) from 1987 to 2020 aimed to determine the incidence of waitlisting for and completion of KT/pHT, risk factors for KT/pHT, and risk factors for nonreceipt of a KT/pHT. Among pHT recipients, 3.4% were waitlisted for KT/pHT (median time of 14 years after pHT). Among those waitlisted, 70% received a KT/pHT, and 18% died on the waitlist at a median time of 0.8 years from KT/pHT waitlisting (median age of 20 years). Moderate-high sensitization at KT/pHT waitlisting (calculated panel reactive antibody, ≥ 20%) was associated with a lower likelihood of KT/pHT (adjusted hazard ratio, 0.67; 95% confidence interval, 0.47-0.95). Waitlisting for heart transplantation simultaneously with kidney transplant (adjusted hazard ratio, 3.73; 95% confidence interval, 2.01-6.92) was associated with increased risk of death on the KT/pHT waitlist. While the prevalence of KT/pHT is low, there is substantial mortality among those waitlisted for KT/pHT. These findings suggest a need to consider novel risk factors for nonreceipt of KT/pHT and death on the waitlist in prioritizing criteria/guidelines for simultaneous heart-kidney transplantation.

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