• Seth A Hollander, Maria E Montez-Rath, David M Axelrod, Catherine D Krawczeski, Lindsay J May, Katsuhide Maeda, David N Rosenthal, and Scott M Sutherland.
• Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA. Electronic address: seth.hollander@stanford.edu.
• Am. J. Kidney Dis. 2016 Aug 1; 68 (2): 212-8.

BackgroundAcute kidney injury (AKI) is common in children following surgery for congenital heart disease and has been associated with poor long-term kidney outcomes. Children undergoing heart transplantation may be at increased risk for the development of both AKI and chronic kidney disease (CKD). This study examines AKI rates in children, adolescents, and young adults after heart transplantation and analyzes the relationship between AKI and CKD in this population.Study DesignRetrospective cohort study.Setting & Participants88 young patients who underwent heart transplantation at Lucile Packard Children's Hospital, Stanford, CA, September 1, 2007, to November 30, 2013.PredictorThe primary independent variable was AKI within the first 7 postoperative days, ascertained according to the KDIGO (Kidney Disease: Improving Global Outcomes) creatinine criteria (increase in serum creatinine ≥ 1.5 times baseline within 7 days).OutcomesRecovery from AKI at 3 months, ascertained as serum creatinine level < 1.5 times baseline; and development of CKD at 6 and 12 months, ascertained as estimated glomerular filtration rate < 60mL/min/1.73m(2) for more than 3 months.Results63 (72%) patients developed AKI; 57% had moderate (stage 2 or severe stage 3) disease. Recovery occurred in 39 of 63 (62%), 50% for stage 2 or 3 versus 78% for stage 1 (P=0.04). At 6 and 12 months, 3 of 82 (4%) and 4 of 76 (5%) developed CKD, respectively. At both time points, CKD was more common in those without recovery (3/22 [14%] vs 0/38 (0%); P=0.04, and 3/17 (18%) vs (0/34) 0%; P=0.03, respectively).LimitationsRetrospective design, small sample size, and single-center nature of the study.ConclusionsAKI is common after heart transplantation in children, adolescents, and young adults. Nonrecovery from AKI is more common in patients with more severe AKI and is associated with the development of CKD during the first year.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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