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Fading renal hyperfiltration in children following liver transplantation
M Schell1, A Lachaux, A Hadj-Aïssa
1Département de Pédiatrie, H pital Edouard Herriot, Lyon, France.
Insights
Orthotopic liver transplantation (OLT) in children can cause early renal function (RF) changes due to the loss of pre-existing hyperfiltration. Cyclosporin A (CsA) did not show nephrotoxic effects in this study.
Area of Science:
- Nephrology
- Pediatric Gastroenterology
- Transplantation Medicine
Background:
- Orthotopic liver transplantation (OLT) is a critical procedure for children with end-stage liver disease.
- Renal function (RF) can be affected by OLT, with potential concerns regarding pre-existing hyperfiltration and drug toxicity.
- Cyclosporin A (CsA) is commonly used post-transplant but carries a risk of nephrotoxicity.
Purpose of the Study:
- To investigate renal function (RF) changes in children before and after OLT.
- To assess the impact of pre-transplant hyperfiltration on post-OLT renal outcomes.
- To evaluate the clinical nephrotoxic effects of CsA in pediatric OLT recipients.
Main Methods:
- Prospective longitudinal study of 23 children undergoing OLT.
- Exclusion of children with pre-existing decreased RF.
- Measurement of glomerular filtration rate (GFR) and effective renal plasma flow (RPF) using inulin and para-amino hippurate clearances, respectively.
Main Results:
- Hyperfiltration (high GFR and RPF) was observed in 6 out of 13 children prior to OLT.
- A significant decrease in RF was noted 6 months post-OLT, primarily due to the loss of hyperfiltration in these 6 children.
- No significant difference in RF was observed before and 6 months post-OLT in the other 7 children.
- No correlation was found between CsA trough blood levels and RF over a 36-month follow-up period.
Conclusions:
- Pediatric OLT can lead to early changes in renal function, specifically the loss of pre-existing hyperfiltration.
- CsA did not demonstrate significant nephrotoxic effects in this cohort of pediatric OLT patients.
- Renal function remained stable throughout the 36-month follow-up period in children without pre-existing renal impairment.
Abstract:
In a prospective longitudinal study, we investigated the renal function (RF) of 23 children before and after orthotopic liver transplantation (OLT). The aim was to assess both the outcome of pretransplant hyperfiltration and the clinical nephrotoxic effects of cyclosporin A (CsA); children with decreased RF prior to OLT were therefore excluded. The RF study of the 13 remaining patients included glomerular filtration rate (GFR) and effective renal plasma flow (RPF) measured by inulin (Cin: mL/min/1.73 m2) and para-amino hippurate (Cpah: mL/min/1.73 m2) clearances, respectively. Hyperfiltration prior to OLT was observed in six children, i.e. Cin>170 [range 172-230] and Cpah>800 [808-1,133]. A significant decrease in RF was noted as soon as 6 months after OLT: Cin (mean+/-SD)=107+/-23 vs. 158+/-46 (p<0.003); Cpah=583+/-119 vs. 791+/-243 (p<0.004). This was due to loss of hyperfiltration in the six children, as there was no significant difference in RF before and 6 months after OLT in the other seven children. With a 36-month follow-up, there was no correlation between CsA trough blood level and RF. In conclusion, following OLT, RF underwent early changes owing to loss of prior hyperfiltration in children without impaired RF before OLT. In addition, no evidence of CsA nephrotoxicity was found and RF remained stable during follow-up.