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Associated Factors And Impact Of Persistent Renal Dysfunction In Children Listed For Heart Transplantation
Jaimin Trivedi1, Shriprassad Deshpande2, Joshua Sparks1, Deborah Kozik1, Erle Austin1, Sarah Wilkens1, Bahaaldin Alsoufi1.
1University of Louisville, Louisville, KY, USA, 2Children's National Hospital, Washington, DC, USA.

Objectives: We evaluated the impact of significant renal dysfunction (SRD) on listing and pediatric heart transplantation (PHT) outcomes using UNOS database.
Methods: 11625 children were listed (2000-2020). At listing, 1494 (13%) had SRD defined as eGFR <45mL/min or dialysis requirement. Factors associated with waitlist mortality, persistent SRD at PHT, and post-PHT survival were assessed.
Results: On adjusted comparison to children with eGFR>45mL/min, those with SRD had higher waitlist mortality (37%vs.14%,p<0.01), and lower transplantation rate (51%vs.71%,p<0.01). 767/1494 of listed children with SRD received PHT. Among them, 406 (53%) had improved renal function (eGFR>45mL/min with no dialysis) at transplantation and 361 (47%) had persistent SRD. Those with persistent SRD were older, more likely to be on dialysis or have listing eGFR<30mL/min, more likely to be ventilated or require ECMO, less likely to receive VAD prior to PHT. On multivariable analysis, factors associated with persistent SRD were: age (OR=1.12per1-Y,95%CI=1.03-1.23,p=0.01), mechanical ventilation (OR=2.10,95%CI=1.45-4.94,p<0.01), ECMO (OR=1.63,95%CI=1.02-2.60,p=0.04), and not using VAD (OR=0.48(VAD use),95%CI=0.27-0.84,p=0.01). Gender, race, cardiac pathology, dialysis, eGFR<30mL/min weren’t significant. Eight-year survival following PHT was 72%,70%,53% (p<0.01) for PHT with improved renal function, combined heart/kidney transplantation (n=69), PHT with persistent SRD, respectively.
Conclusions: SRD is associated with higher waitlist mortality and decreased transplantation rate. Persistent SRD decreased post-PHT survival. Attempts to modify these such as VAD use to enhance kidney recovery or listing for combined heart/kidney transplantation should be considered.


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