High prevalence of renal dysfunction in children after liver transplantation: non-invasive diagnosis using a cystatin
Florian Brinkert1, Markus J Kemper, Andrea Briem-Richter
1Department of Pediatrics, Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. f.brinkert@uke.de
Insights
Serum cystatin C accurately detects chronic kidney disease (CKD) in children after liver transplantation (LTx), unlike less sensitive creatinine-based formulas. Early detection of renal dysfunction is crucial for long-term patient outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Biomarker Research
Background:
- Chronic kidney disease (CKD) is a significant negative prognostic factor post-liver transplantation (LTx).
- Standard creatinine-based glomerular filtration rate (GFR) formulas often underestimate renal dysfunction.
- Serum cystatin C offers a feasible, non-invasive method for GFR assessment in children, correlating well with gold standards.
Purpose of the Study:
- To compare GFR measurements using cystatin C (GFR(cys)) versus creatinine clearance (GFR(crea)) in children post-pediatric liver transplantation (pLtx).
- To assess the prevalence of CKD in long-term follow-up after pLtx.
- To identify risk factors for CKD, including immunosuppressive treatment.
Main Methods:
- GFR was determined in 168 children post-LTx using cystatin C and the Schwartz formula (creatinine-based).
- Logistic regression and multivariate models were used to analyze risk factors and the impact of immunosuppression.
- Bland-Altman analysis was employed to assess agreement between GFR measurement methods.
Main Results:
- Cystatin C detected significantly more cases of CKD (34 patients) than creatinine clearance (3 patients), P < 0.001.
- CKD prevalence using GFR(cys) was 30.4% at 5 years, 7.6% at 10 years, and 27% beyond 10 years post-LTx.
- Cyclosporine use was associated with lower GFR compared to tacrolimus; no significant risk factors for CKD were identified.
Conclusions:
- The cystatin C equation is a sensitive, non-invasive tool for early detection of renal dysfunction in pediatric liver transplant recipients.
- The choice of initial calcineurin inhibitor significantly impacts the development of CKD.
Background:
Chronic kidney disease (CKD) has been increasingly shown to be a negative prognostic factor after liver transplantation (Ltx). Creatinine-based glomerular filtration rate (GFR) formulas are notoriously insensitive. In children, non-invasive determination of GFR by measurement of serum cystatin C is feasible and repeatedly correlated to the gold standards of GFR measurements. The aim of our study was to determine GFR using cystatin C (GFR(cys)) in comparison with conventional calculated creatinine clearance (GFR(crea)) in the long-term follow-up after paediatric liver transplantation (pLtx) in a large number of patients.
Methods:
GFR of 168 children following liver transplantation was determined using cystatin C (GFR(cys)) and the Schwartz formula (GFR(crea)). In order to evaluate risk factors for CKD, a logistic regression analysis was performed. A multivariate model was applied to assess the impact of immunosuppressive treatment.
Results:
The mean follow-up after transplantation was 7.8 (0.44-15.72) years. Due to a high overestimation of GFR as demonstrated in a Bland-Altman plot, only three patients with CKD stages 2-3 were detected with GFR(crea) compared with 34 with GFR(cys) (P < 0.001). Thus, prevalence of CKD with GFR((cys)) < 90 mL/min/1.73 m2; was 30.4%, 7.6% and 27% in patients with 5, 10 and > 10 years of follow-up, respectively. Patients on cyclosporine had a significantly lower GFR than patients on tacrolimus. Logistic regression analysis did not show any significant risk factor for the development of CKD.
Conclusions:
The cystatin C equation is a non-invasive and sensitive diagnostic tool to detect renal dysfunction in children after Ltx at an early stage. The choice of first-line calcineurin inhibitor has an important impact on the development of CKD.
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