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Acute kidney injury and chronic kidney disease after non‐kidney solid organ transplantation
Author(s) -
Me Shina,
Pollack Ari H.,
Sullivan Erin,
Murphy Tasha,
Smith Jodi
Publication year - 2020
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13753
Subject(s) - medicine , kidney disease , incidence (geometry) , acute kidney injury , cumulative incidence , retrospective cohort study , perioperative , creatinine , liver transplantation , transplantation , kidney transplantation , cohort , heart transplantation , gastroenterology , surgery , physics , optics
Background SOT is the treatment of choice for end‐stage organ disease. Improved long‐term survival after NKSOT has uncovered chronic morbidity including CKD. AKI is common after NKSOT and may be associated with long‐term CKD. Methods We performed a retrospective cohort study looking at AKI and CKD after pediatric heart (n = 109) or liver (n = 112) transplant. AKI was defined using KDIGO creatinine‐based criteria. pAKI was AKI ≤ 7 days post‐transplant; CKD 3‐5 was eGFR < 60 mL/min/1.73 m 2 by modified Schwartz formula for > 3 months. We looked at the incidence of CKD 3‐5 and the effect of perioperative pAKI on the slope of eGFR post‐transplant. Results pAKI was seen in 63% (n = 69) after heart and 38% (n = 43) after liver transplant. pAKI was associated with longer ICU and hospital stays. Cumulative incidence (95% CI) of CKD 3‐5 at 60 months post‐heart transplant was 40.9% (27.9%‐57.1%) in patients with AKI vs 35.8% (17.1%‐64.8%) in those without ( P = NS). Post‐liver transplant, the cumulative incidence of CKD 3‐5 at 60 months was 0% in those without pAKI vs 10% (3.2%‐29.3%) in those with ( P = .01). Patients with pAKI had lower eGFR at last follow‐up. Conclusion pAKI and CKD are common after NKSOT. Incidence of CKD is higher in those with pAKI. AKI episodes are associated with a drop in eGFR during follow‐up. Identifying patients who have had AKI is an important first step in identifying those at risk of repeated AKI episodes. These patients would benefit from closer monitoring for CKD, lower nephrotoxic drug use, and follow‐up with nephrology.