Pre- and post-kidney transplant outcomes of neonates with congenital kidney failure requiring fetal interventions

Abstract Background Fetuses with congenital kidney failure, including bladder outlet obstruction (BOO) and multicystic dysplastic kidney with anhydramnios (MCDKa—includes bilateral MCDK/MCDK with kidney agenesis), require fetal intervention for pulmonary survivorship. However, data on their course to kidney transplant (KTx) and post-transplant outcomes are limited. This study reports pre- and post-KTx outcomes of patients with congenital kidney failure who required fetal interventions. Methods We performed a retrospective chart review of patients who underwent both fetal interventions and KTx at Cincinnati Children’s Fetal Care Center and Cincinnati Children’s Hospital Medical Center before December 31, 2024. To evaluate evolving care practices, patients were stratified into three groups: historical BOO (born 2008–2014), contemporary BOO (born 2016–2022), and contemporary MCDKa (born 2019–2021). Outcomes included prenatal interventions, respiratory support, hospital length of stay (LOS), dialysis, growth, feeding, kidney function, hospital admissions, and graft status. Results Twenty-five patients were included (9 historical BOO, 9 contemporary BOO, 7 MCDKa). All contemporary BOO and MCDKa required amnioinfusions. MCDKa had the lowest birth weights. Contemporary cohorts had longer LOS and earlier dialysis initiation. Many patients had unplanned dialysis modality changes and required hemodialysis at the time of KTx. Median age at KTx ranged from 2.0 to 2.9 years. Patients spent up to 23.7% of life hospitalized pre-transplant. One historical BOO patient required a second KTx. Growth normalized within one-year post-KTx. Conclusions Overall, transplant outcomes are excellent in this complex population, including 7 MCDKa, a diagnosis previously incompatible with life without amnioinfusions. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information.