Late renal dysfunction after pediatric heart transplantation. (June 2016)

• Record Type: Journal Article
• Authors: Jain, Amrish; Mattoo, Tej K.
• Is Part Of: Progress in pediatric cardiology. Volume 41(2016)
• Page Start: 41
• Page End: 45
• Publication Date: 2016-06
• Subjects: Renal insufficiency -- Chronic kidney disease -- Heart transplantation -- Children; Pediatric cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; Infant; Child; Cardiologie pédiatrique -- Périodiques; 618.9212005
• DOI: 10.1016/j.ppedcard.2015.12.004
• Languages: English
• ISSNs: 1058-9813

Abstract

Abstract: Acute as well as chronic renal dysfunctions are a common complication after pediatric heart transplantation and both increase the risk of post transplant morbidity and mortality. The severity of chronic kidney disease after heart transplantation varies from mild dysfunction to end stage renal disease requiring dialysis and/or renal transplantation. Multiple risk factors are involved including preexisting renal disease, peri-transplant hemodynamic renal insults and long-term exposure to calcineurin inhibitors post-transplant. Close monitoring and surveillance of renal function, high blood pressure, and proteinuria are recommended to detect chronic kidney disease at an early stage. Use of calcineurin inhibitor sparing regimens with a close monitoring of drug levels can help slow the progression. In order to prevent further injury, renal protective strategies should be started early in collaboration with a pediatric nephrologist. Highlights: Late renal dysfunction or CKD after pediatric heart transplantation is a common complication. Chronic CNI toxicity is a major risk factor for CKD. Active surveillance is recommended to detect CKD at an early stage and begin renoprotective strategies. CNI minimization or replacement regimens may be helpful in slowing progression. A collaborative approach with an early involvement of pediatric nephrologist is recommended.