We know children with advanced heart failure often experience renal dysfunction (RD). This analysis expanded clinical knowledge on changes in renal function after left ventricular assist device (LVAD) placement in this population: “Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis.” This important data analysis was published in The Journal of Heart and Lung Transplantation in October of 2018. It included 247 pediatric LVAD recipients from 39 centers enrolled in Pedimacs between 9/19/2012 and 6/30/2016, using logistic regression to identify factors associated with lack of improvement in renal function after LVAD placement and the Kaplan‒Meier method to assess post-LVAD outcomes.
The results? 61% patients experienced baseline RD (estimated glomerular filtration rate [eGFR] <90 ml/min/1.73 m2). Ultimately, eGFR improved post-LVAD, peaking at 1 month post-implant. Researchers identified an inverse relationship between baseline eGFR and the degree of improvement at 1 month. Device type, age, INTERMACS profile, or diagnosis did not impact degree of improvement. Furthermore, persistent RD at 1 month was correlated with failure to normalize renal function at 1 week, and children stratified by pre-implant renal function did not have different post-implant outcomes.
The researchers, including ACTION leaders Joshua Friedland-Little of Seattle Children’s Hospital and Steven Kindel of Children’s Hospital of Wisconsin, concluded that renal function improves post-LVAD placement in children regardless of age, diagnosis, illness severity, or device type, and improvement is most pronounced in patients with baseline RD. Irreversible renal dysfunction remains difficult to identify before LVAD placement. Survival to transplant does not appear to be impacted by pre-LVAD renal function.
Friedland-Little JM, Hong BJ, Gossett JG, Deshpande SR, Law S, Hollifield KA, Cantor RS, Koehl D, Kindel SJ, Turrentine MW, Davies RR. Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis. J Heart Lung Transplant. 2018 Oct;37(10):1218-1225. doi: 10.1016/j.healun.2018.06.016. Epub 2018 Jul 24. PMID: 30293616.