Renal replacement therapy after paediatric heart transplant: who gets it and associated outcomes

Background: Renal replacement therapy is sometimes utilised after paediatric heart transplant, although current data on this are extremely limited. We sought to identify incidence of renal replacement therapy and patient characteristics, comorbidities, and outcomes when renal replacement therapy was needed around paediatric heart transplant. Materials and methods: The Pediatric Health Information System database was queried for paediatric intensive care patients who underwent a heart transplant from 2018 to 2021. Demographic and clinical data were analysed. Only patients admitted for heart transplant with heart transplant occurring on day 0 of admission were included to ensure that renal replacement therapy was postoperative. Results: A total of 235 patients who underwent heart transplant were included. Of these, 22 (9.3%) required renal replacement therapy. Mortality during admission was 3.8% in those without renal replacement therapy and 40.9% of patients requiring renal replacement therapy. Renal replacement therapy was associated with cardiomyopathy, infection, rejection, acute kidney injury, acute hepatic failure, and fluid overload. Conclusions: Renal replacement therapy was utilised in 9.3% of paediatric heart transplant admissions and is associated with increased mortality. Postoperative need for renal replacement therapy is associated with increased mortality and adverse transplant outcomes.