End-Stage Renal Disease and Cardiomyopathy in Children: Cardiac Effects of Renal Transplantation

Lal, Ashwin K.1,3; de Biasi, Andreas R.2; Alexander, Steve1; Rosenthal, David N.1; Sutherland, Scott M.1

doi: 10.1097/TP.0b013e31823be7f8
Clinical and Translational Research

Background. The occurrence and progression of cardiomyopathy is well known in patients with end-stage renal disease (ESRD). However, the feasibility of renal transplantation in the setting of cardiac dysfunction and the effect of renal transplantation on this progression remain poorly studied in pediatric patients.

Methods. A single-center, retrospective review of pediatric renal transplants between January 1, 2001, and December 31, 2010, was conducted. Six children with ESRD and severe systolic dysfunction underwent renal transplantation. Clinical data were collected and compared for the pretransplant, peritransplant, and posttransplant periods.

Results. Nutritional support, dialysis, and chronic kidney disease and heart failure therapy led to improved cardiac function before transplantation (ejection fraction 28.8%±9.6% vs. 44.4%±11.5%; fractional shortening 12.7%±5.1% vs. 23.6%±6.2%); however, normal systolic function was not achieved before transplantation in any patient. After transplantation, two patients had normalization of systolic function by hospital discharge, while the systolic function of the remaining four patients normalized during the first posttransplant year. Mean ejection fraction 1 year posttransplant was 22 units greater than before transplant. All patients experienced excellent allograft function in the peritransplant period. Mean estimated creatinine clearance 1 year posttransplant was 93.2±33.3 mL/min/1.73 m2.

Conclusions. Renal transplantation can be performed safely in children with ESRD and severe systolic dysfunction. After transplantation, systolic function continues to improve and may reach normal levels during the first posttransplant year. The presence of severe systolic dysfunction in pediatric dialysis patients should not deter referral for renal transplantation.

1Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA.

2University of Maryland School of Medicine, Baltimore, MD.

The authors declare no funding or conflicts of interest.

Address correspondence to: Ashwin K. Lal, M.D., Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Palo Alto, CA 94305. E-mail: alal@stanford.edu

D.N.R. and S.M.S. participated in research design. A.K.L., A.R.d.B., S.A., D.N.R., and S.M.S. participated in the writing of the manuscript. A.K.L., A.R.d.B., and S.M.S. participated in the performance of the research. A.K.L. and S.M.S. participated in data analysis. S.A., D.N.R., and S.M.S. provided clinical care for patients.

Received 17 July 2011. Revision requested 21 August 2011.

Accepted 6 October 2011.

© 2012 Lippincott Williams & Wilkins, Inc.