Severe post-transplant AKI was independently associated with higher biventricular filling pressures over the first two years post-transplant, suggesting a clinically relevant kidney-heart interaction in pediatric heart transplant recipients.
Post-operative AKI occurred in 29% of pediatric heart transplant patients, with severe AKI (Stage 2 or 3) in more than half of those cases.
AKI was significantly more common in patients with congenital heart disease (CHD) than in those with cardiomyopathy.
Severe post-operative AKI was independently associated with higher right ventricular end-diastolic pressure (RVEDP) over the first two years post-transplant.
Severe post-operative AKI was independently associated with higher pulmonary capillary wedge pressure (PCWP) over the first two years post-transplant.
Severe post-transplant AKI was independently associated with higher biventricular filling pressures, suggesting a clinically relevant kidney-heart interaction.
This research examined whether kidney injury occurring right after a heart transplant in children is linked to how well the transplanted heart fills with blood in the months and years that follow. Researchers looked back at records of 101 children and young adults (ages 0–20) who received their first heart transplant at a single center over a 13-year period. They found that about 29% of patients developed acute kidney injury (AKI) after surgery, and just over half of those cases were classified as severe. Patients who had congenital heart disease before transplant were more likely to develop AKI than those with cardiomyopathy. The key finding was that patients who experienced severe AKI after surgery had measurably higher cardiac filling pressures — in both the right and left sides of the heart — during routine heart catheterization checkups over the following two years. Specifically, severe AKI was linked to about a 2.2 mmHg higher pressure on the right side of the heart and 1.8 mmHg higher pressure on the left side, even after accounting for other factors like the type of heart disease and how long the donor heart was outside the body before transplant. Elevated filling pressures can be a sign that the heart muscle is stiffer and not relaxing as well as it should. This research suggests that kidney injury after pediatric heart transplantation may have lasting effects on how the transplanted heart functions — a relationship sometimes called a 'kidney-heart interaction.' While the pressure differences found were modest, they were statistically significant and persisted over time. The authors call for larger studies to better understand why this happens and what it might mean for long-term care of children who receive heart transplants.
Zafar F, Gist K, Floh A, Ollberding N, Fuhrman D, Soranno D. (2026). Post-Operative Acute Kidney Injury After Pediatric Heart Transplantation and Longitudinal Invasive Assessment of Cardiac Filling Pressures.. Pediatric transplantation. https://doi.org/10.1111/petr.70503