J Pediatr Intensive Care 2024; 13(01): 037-045
DOI: 10.1055/s-0041-1736336
Original Article

Intraoperative and Postoperative Hemodynamic Predictors of Acute Kidney Injury in Pediatric Heart Transplant Recipients

1   Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, United States
2   Quantitative Sciences Unit, Stanford University, Stanford, California, United States
Sushma Reddy
1   Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, United States
3   Department of Pediatrics, Stanford University, Stanford, California, United States
3   Department of Pediatrics, Stanford University, Stanford, California, United States
Tristan Vella
4   Perfusion Services, Lucile Packard Children's Hospital Stanford, Palo Alto, California, United States
Manchula Navaratnam
5   Department of Anesthesia, Stanford University School of Medicine, Stanford, California, United States
Elizabeth Price
6   Patient Care Services, Cardiovascular Intensive Care Unit, Lucile Packard Children's Hospital Stanford, Palo Alto, California, United States
Scott M. Sutherland
7   Department of Pediatrics (Nephrology), Scott M Sutherland, Stanford University School of Medicine, Stanford, California, United States
Claudia A. Algaze
1   Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, United States
8   Center for Pediatric and Maternal Value, Stanford University, Palo Alto, California, Unites States
› Author Affiliations


Acute kidney injury (AKI) is common after pediatric heart transplantation (HT) and is associated with inferior patient outcomes. Hemodynamic risk factors for pediatric heart transplant recipients who experience AKI are not well described. We performed a retrospective review of 99 pediatric heart transplant patients at Lucile Packard Children's Hospital Stanford from January 1, 2015, to December 31, 2019, in which clinical and demographic characteristics, intraoperative perfusion data, and hemodynamic measurements in the first 48 postoperative hours were analyzed as risk factors for severe AKI (Kidney Disease: Improving Global Outcomes [KDIGO] stage ≥ 2). Univariate analysis was conducted using Fisher's exact test, Chi-square test, and the Wilcoxon rank-sum test, as appropriate. Multivariable analysis was conducted using logistic regression. Thirty-five patients (35%) experienced severe AKI which was associated with lower intraoperative cardiac index (p = 0.001), higher hematocrit (p < 0.001), lower body temperature (p < 0.001), lower renal near-infrared spectroscopy (p = 0.001), lower postoperative mean arterial blood pressure (MAP: p = 0.001), and higher central venous pressure (CVP; p < 0.001). In multivariable analysis, postoperative CVP >12 mm Hg (odds ratio [OR] = 4.27; 95% confidence interval [CI]: 1.48–12.3, p = 0.007) and MAP <65 mm Hg (OR = 4.9; 95% CI: 1.07–22.5, p = 0.04) were associated with early severe AKI. Children with severe AKI experienced longer ventilator, intensive care, and posttransplant hospital days and inferior survival (p = 0.01). Lower MAP and higher CVP are associated with severe AKI in pediatric HT recipients. Patients, who experienced AKI, experienced increased intensive care unit (ICU) morbidity and inferior survival. These data may guide the development of perioperative renal protective management strategies to reduce AKI incidence and improve patient outcomes.

Publication History

Received: 05 August 2021

Accepted: 28 August 2021

Article published online:
08 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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