Related Experiment Videos

Stable long-term renal function after pediatric liver transplantation

Gustaf Herlenius1, Sverker Hansson, Marie Krantz

  • 1Transplant Institute, Sahlgrenska University Hospital, Göteborg, Sweden. gustaf.herlenius@gmail.com

Pediatric Transplantation
|March 25, 2010
PubMed

Insights

Pediatric liver transplant recipients experienced a significant initial drop in kidney function, but renal function stabilized long-term. Most children did not develop chronic kidney disease (CKD) stage III by year five, suggesting potential renal recovery post-transplant.

Area of Science:

  • Pediatric Nephrology
  • Hepatology
  • Transplantation Medicine

Background:

  • Calcineurin inhibitors used post-liver transplant (LT) are associated with increased risk of chronic kidney disease (CKD) in children.
  • Understanding long-term renal function after pediatric LT is crucial for patient management and prognosis.

Purpose of the Study:

  • To assess renal function (glomerular filtration rate - GFRm) before and annually after pediatric LT.
  • To determine the prevalence of CKD stage III (GFR 30-60 mL/min/1.73 m²) post-LT.
  • To investigate the impact of patient age at LT and underlying liver disease on long-term renal function.

Main Methods:

  • Prospective study of 36 children undergoing LT, with median follow-up of 6.5 years.
  • GFRm was measured before LT and annually thereafter.
  • Analysis included patient age at LT, underlying liver disease etiology, and CKD prevalence.

Main Results:

  • A significant 23% decrease in GFRm occurred within the first six months post-LT, followed by stabilization.
  • CKD stage III prevalence was 17% at six months and 18% at five years, but 0% at ten years.
  • Children transplanted younger than two years showed a smaller initial GFRm decrease (13%) compared to older children (31%); however, renal function stabilized in both groups.

Conclusions:

  • Pediatric liver transplant recipients experience an initial decline in renal function, but it tends to stabilize over time.
  • The prevalence of CKD stage III is notable in the early post-transplant period but may resolve with longer follow-up.
  • Age at transplantation and underlying liver disease (especially malignancy) can influence the initial renal function decline, but long-term recovery is possible.

Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...