Renal transplantation after previous pediatric heart transplantation

Background: Nephrotoxicity related to calcineurin inhibitors is a known complication after pediatric heart transplantation. Subsequent renal transplantation can be undertaken in advanced cases. An understanding of this strategy is important as many centers are advocating various renal-sparing immunosuppressive regimens-potentially at the cost of increasing heart allograft rejection. Methods: We reviewed the Organ Procurement Transplant Network database to determine the outcome for renal transplantation after pediatric heart transplantation between October 1987 and January 2007. Combined primary heart and kidney transplants were not included in the analysis. Results: During the period of study, 45 subjects underwent renal transplantation. The mean age at renal transplant was 19.7 +/- 6.1 years. Mean interval from primary heart transplantation to renal transplantation was 11.0 +/- 4.2 years. At time of renal transplantation, 35 subjects (78%) were receiving dialysis. The majority of subjects (54%) received a kidney from a deceased donor. Mean land 5-year survival after renal transplantation was 91% at both time-points. This survival rate was not significantly different from that of a matched cohort of pediatric heart transplant recipients who did not require renal transplantation (hazard ratio 0.33, 95% confidence interval 0.08 to 1.35, p = 0.12). Conclusions: Intermediate-term survival for patients who undergo renal transplantation after previous pediatric heart transplantation is favorable.