Children with solid-organ transplants at higher risk of kidney failure

Children who undergo transplants of solid organs have a high risk of developing advanced kidney disease, according to a new national study. Among these children, the highest risk is in those receiving lung or intestinal transplants, followed by heart and then liver transplants. The researchers say their findings reinforce the importance of continued screening of kidney function in pediatric transplant recipients.

“We found that the risk patterns for kidney disease are different among patients who receive solid-organ transplants as children, compared to adult transplant recipients,” said pediatric nephrologist Rebecca L. Ruebner, MD, of The Children’s Hospital of Philadelphia, and first author of a study published online in Pediatrics. “Because chronic and end-stage kidney disease carry high burdens of mortality and serious illness, it is important to take preventive measures to slow or prevent disease progression.”

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Ruebner is the first author of a study published online in Pediatrics. The senior author is Susan L. Furth, M.D., PhD, chief of Nephrology at Children’s Hospital.

Using data from the Scientific Registry of Transplant Recipients, the study team analyzed records of 16,600 pediatric patients who received solid-organ transplants (liver, heart, lung, intestine, and heart-lung) from 1990 to 2010 across the United States. This was the first pediatric study to compare the relative incidence of end-stage renal disease by type of organ transplant. It was also the first analysis to identify the risk of advanced kidney disease among pediatric solid-organ recipients over a 20-year period.

The researchers found that ESRD occurred in 3% of pediatric solid-organ recipients, with the highest risk of ESRD among those who received lung transplants or intestinal transplants. Patients who received liver transplants as children had the lowest rate of ESRD.

In contrast, adult liver transplant recipients are known to have the highest risk of ESRD and adult lung transplant recipients have lower risks of ESRD. For both children and adults, intestinal transplantation carries higher risks of ESRD.

“Although the overall incidence of end-stage kidney disease was only 3%, the broader burden of chronic kidney disease is much higher in this population of pediatric transplant recipients,” said Ruebner. “Children with chronic kidney disease experience a steady decline in kidney function, so we recommend that pediatric health care providers carefully follow post-transplant patients to detect any early signs of kidney problems, with early referral, if necessary, to a pediatric nephrologist.”