title: Acute kidney injury after heart transplant in young children: risk factors and outcomes.
abstract: BACKGROUND
  Critical illness following heart transplantation can include acute kidney injury (AKI). Study objectives were to define the epidemiology of, risk factors for, or impact on outcomes of AKI after pediatric heart transplant.
  
  
  METHODS
  Using data from a prospective study of 66 young children, we evaluated: (1) post-operative AKI rate (by pediatric modified RIFLE criteria); (2) pre, intra, and early post-operative AKI risk factors using stepwise logistic regression (3) effect of AKI on short-term outcomes (ventilation and length of pediatric intensive care unit (PICU) stay) using stepwise multiple regression.
  
  
  RESULTS
  AKI occurred in 73 % of children. Pre-transplant ventilation and higher baseline estimated creatinine clearance (eCCl) were independent risk factors for AKI. Pre-operative inotrope use was associated with reduced risk of AKI. Tacrolimus level emerged as important in multivariable risk prediction. Children with AKI had a longer duration of ventilation and length of pediatric intensive care unit (PICU) stay, with AKI being an independent predictor.
  
  
  CONCLUSIONS
  AKI was common after heart transplant and associated with more complicated early post-transplant course. Lower baseline eCCl was associated with lower incidence of AKI; this merits further investigation. The association of pre-operative inotropes with less AKI may reflect a pathophysiological mechanism or be a surrogate for clinical factors and management prior to transplant. Avoiding high tacrolimus levels may be a modifiable risk factor for AKI.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: MacDonald
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Norris
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Gwen Y
authors.initials: GY
authors.lastname: Alton
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.|Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Urschel
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.|Women and Children's Health Research Institute, Edmonton, Alberta, Canada.
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. cmorgan@ualberta.ca.|Women and Children's Health Research Institute, Edmonton, Alberta, Canada. cmorgan@ualberta.ca.|, Room 4-557 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, Canada, T6G 1C9. cmorgan@ualberta.ca.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Morgan
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012042:Registries; D012121:Respiration, Artificial; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Cardiac surgery-associated AKI; Cardiac transplant; Pediatric; Renal failure