Kidney Transplantation in Congenital Heart Disease Patients: What Are the Outcomes?

TL;DR

Patients with congenital heart disease who undergo kidney transplants have higher in-hospital resource use but similar long-term outcomes compared to others.

Contribution

This study provides the first detailed analysis of kidney transplant outcomes in congenital heart disease patients using a large pediatric database.

Findings

CHD patients had a 9% longer hospital stay compared to non-CHD patients.

CHD patients were more likely to require prolonged mechanical ventilation and blood transfusions.

No significant difference in long-term transplant survival was found between CHD and non-CHD patients.

Abstract

Congenital heart disease (CHD) patients experience risks for renal failure, including low cardiac output, exposure to nephrotoxic agents, and surgical interventions. Outcomes of kidney transplantation in CHD patients remain underexplored.

A retrospective review of the Pediatric Health Information System database from 1/1/04–10/30/23. All patients < 18 years who underwent kidney transplantation were included. Multi‐organ transplants were excluded. International Classification of Diseases 9th and 10th editions were utilized to identify patients with a diagnosis consistent with CHD.

A total of 7586 patients were identified, with 3109 (41%) female, 3833 (51%) white non‐Hispanic, and a median age of 13 [IQR:7–16] years at transplant. A CHD diagnosis was present in 181 (2%). CHD patients were more likely to have mechanical ventilation > 96 h (n = 54 (30%) vs. n = 1264 (17%), p < 0.001) and red blood cell transfusion (n = 48 (27%) vs. n = 1452 (20%, p = 0.026)). On multivariable analysis, CHD was associated with a 9% (95% CI: 2.5–17.1) increase in length of stay (p = 0.007) and was not associated with an increased risk for 30‐day readmission (OR: 0.88; CI: 0.62–1.26, p = 0.509). Over a median follow‐up of 2.6 [IRQ: 0.7–5.7] years, no difference in re‐transplant free survival was evident.

CHD patients have increased inhospital resource utilization compared to non‐CHD, but no difference in long‐term outcomes. However, differences in willingness to transplant cannot be assessed with this data. Further work is needed to better understand the impact of CHD on management decisions and outcomes across the kidney disease continuum.

Patients with congenital heart disease (CHD) undergoing kidney transplant experience prolonged length of stay, increased risk for requiring prolonged mechanical ventilation, and posttransplant red blood cell transfusion. Overall, patients with CHD experienced similar long‐term outcomes.

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