Background: Renal function is abnormal in patients with end stage graft failure due to hemodynamic compromise and chronic exposure to nephrotoxic medications. The purpose of this study was to evaluate changes in estimated glomerular filtration rate (eGFR) before and after cardiac retransplantation (ReTx) in children and young adults. We hypothesized that eGFR would transiently decrease and then normalize post-ReTx.
Methods: We reviewed all ReTx patients at our institution from 1995-2011. eGFR was calculated using the modified Schwartz equation pre-ReTx, at peak creatinine (Cr) in the first week after ReTx, and at 1-3, 6 and 12 months post-ReTx. Changes in eGFR were analyzed within patients using a linear mixed effect model. Change in eGFR was also compared within pre-ReTx eGFR levels of <60 ml/min/1.73m2 (N=23) and ≥60 (N=14). Associations between eGFR pre-ReTx, and change in eGFR from pre-ReTx to first post-op week, and pre-ReTx hemodynamics, bypass time, ischemic time, and length of ICU and hospital stay were assessed using linear regression.
Results: ReTx was performed in 38 patients with 1 excluded (early death). Age at ReTx was 13±6.5 yr. Race was 82% white and 13% Hispanic. Reason for ReTx was chronic rejection (45%), coronary disease (34%), acute rejection (8%), primary graft failure (5%), and other (8%). Figure 1 shows differences in mean eGFR at the specified time points. Those with a pre-ReTx eGFR <60 rebounded to levels significantly higher than pre-ReTx (p<0.001). There was no association between eGFR pre-ReTx, or change in eGFR from pre to post-ReTx, and pre-ReTx hemodynamics, bypass or ischemic time, or length of stay.
Conclusions: While eGFR falls significantly post-ReTx, it does not affect length of stay and rebounds above pre-ReTx levels within 3 months. These findings are useful in the care of the ReTx patient as they allow for an anticipated decrease in eGFR postoperatively while simultaneously providing expectation of early recovery of renal function.
To cite this abstract in AMA style:Gralla J, Auerbach S, Connell C, Mitchell M, Campbell D, Jaggers J, Miyamoto S, Pietra B. Estimated Glomerular Filtration Rate Decreases Transiently Following Repeat Heart Transplantation in Children and Young Adults [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/estimated-glomerular-filtration-rate-decreases-transiently-following-repeat-heart-transplantation-in-children-and-young-adults/. Accessed December 4, 2020.
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