O'Connor Mario, Adler Joel T, Hoyos Maria E, Taylor Michael D, Venardos Neil M, Mery Carlos M, Fraser Charles D, Well Andrew
Texas Center for Pediatric and Congenital Heart Disease, Dell Children's and UT Health, Austin, Texas, USA.
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA.
Pediatr Transplant. 2025 Aug;29(5):e70117. doi: 10.1111/petr.70117.
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.
先天性心脏病（CHD）患者面临肾衰竭风险，包括心输出量低、接触肾毒性药物和手术干预。CHD患者肾移植的结果仍未得到充分研究。
对2004年1月1日至2023年10月30日的儿科健康信息系统数据库进行回顾性分析。纳入所有接受肾移植的18岁以下患者。排除多器官移植。使用国际疾病分类第9版和第10版来识别诊断符合CHD的患者。
共识别出7586例患者，其中3109例（41%）为女性，3833例（51%）为非西班牙裔白人，移植时的中位年龄为13岁[四分位间距：7 - 16岁]。181例（2%）患者诊断为CHD。CHD患者更有可能机械通气超过96小时（n = 54例（30%）对n = 1264例（17%），p < 0.001）以及接受红细胞输血（n = 48例（27%）对n = 1452例（20%），p = 0.026）。多变量分析显示，CHD与住院时间延长9%（95%置信区间：2.5 - 17.1）相关（p = 0.007），且与30天再入院风险增加无关（比值比：0.88；置信区间：0.62 - 1.26，p = 0.509）。中位随访2.6年[四分位间距：0.7 - 5.7年]，再次移植自由生存率无明显差异。
与非CHD患者相比，CHD患者住院资源利用率更高，但长期结局无差异。然而，该数据无法评估移植意愿的差异。需要进一步开展工作，以更好地了解CHD对整个肾脏疾病连续过程中管理决策和结局的影响。
