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Renal function before and long after liver transplantation in children
U B Berg1, B G Ericzon, A Nemeth
1Department of Paediatrics, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
Transplantation
|September 7, 2001
Summary
Orthotopic liver transplantation (OLT) in children impairs renal function, which declines further post-transplant. Accurate measurement of glomerular filtration rate (GFR) is crucial, as creatinine clearance is unreliable.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Transplantation Medicine
Background:
- Renal dysfunction is common in children with liver disease and can worsen after liver transplantation.
- Current methods for assessing renal function in these patients are often inaccurate.
- This study investigates renal function changes before and after liver transplantation using precise methods.
Purpose of the Study:
- To analyze the impact of underlying diseases, hypertension, and immunosuppressive agents on renal function post-liver transplantation.
- To evaluate changes in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) after OLT.
- To compare the accuracy of inulin clearance with estimated creatinine clearance for GFR determination.
Main Methods:
- Studied 46 children before and annually after orthotopic liver transplantation (OLT).
- Measured glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) using inulin and paraaminohippuric acid clearances.
- Compared inulin clearance with formula creatinine clearance for GFR estimation.
Main Results:
- GFR and ERPF decreased after OLT and continued to decline in the initial years.
- Patients with extrahepatic biliary atresia and tumors had higher GFR post-OLT compared to those with metabolic disorders.
- Creatinine clearance calculations showed significant disagreement with inulin clearance-based GFR.
- Tacrolimus-treated patients showed higher GFR at 4 years compared to cyclosporine-treated patients.
- Antihypertensive treatment was associated with lower GFR.
Conclusions:
- Orthotopic liver transplantation (OLT) reduces renal function in children, with further decline in the early post-transplant years.
- Metabolic disorders and antihypertensive treatment are linked to the lowest GFR.
- Formula creatinine clearance is an inaccurate method for determining GFR in pediatric liver transplant recipients.