title: Chronic kidney disease in children following lung and heart-lung transplantation.
abstract: CKD is a major co-morbidity in pediatric lung transplant recipients. We report the prevalence of renal impairment post-lung transplant at a single center, using a modified, age-adjusted eGFR for the best approximation of true GFR, and investigated associations and possible predictors of decline in renal function post-transplant. Renal function was assessed by eGFR pre-transplant, three and 12 months post-transplant, and at last follow-up. Decline in renal function was analyzed as percentage fall in eGFR in two phases (0-3 and 3-12). Furthermore, we investigated impact of gender, age, pre-transplant diagnosis and renal function, transplant type, early post-transplant dialysis, and tacrolimus trough levels on decline in eGFR using multivariate analysis. Over a five-yr period, 30 transplants were performed. Mean eGFR pretransplant was 117 mL/min/1.73 m(2) (s.d. 35) with mean decline in eGFR during the first three months post-transplant of 33% (s.d. 31, p < 0.001). Thereafter, mean decline in eGFR was 8% (s.d. 18, p = 0.02). None of the factors assessed were significantly associated with decline in eGFR post-transplant. In conclusion, many children have decline in renal function following lung transplantation, particularly early post-transplant. Unlike in adults, we were unable to detect any predictors of renal impairment in pediatric lung transplant recipients.
authors.affiliation: Cardio-Respiratory and Critical Care Division, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.forename: Sonal
authors.initials: S
authors.lastname: Kansra
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Ridout
authors.forename: Nadine L
authors.initials: NL
authors.lastname: Shaw
authors.forename: Paul
authors.initials: P
authors.lastname: Aurora
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Elliott
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D016041:Heart-Lung Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D016559:Tacrolimus / Q000493:pharmacokinetics
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus