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Glomerular filtration rate following pediatric liver transplantation--the SPLIT experience
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Kathleen.campbell@cchmc.org
Insights
Kidney dysfunction affects 17.6% of children post-liver transplant (LT). Key risk factors include immunosuppression, age at LT, and pre-transplant kidney function, informing better pediatric post-transplant care.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Clinical Research
Background:
- Kidney dysfunction is a known complication after liver transplantation (LT).
- Previous pediatric studies on this complication were limited by small sample sizes and less sensitive outcome measures.
- This study addresses the need for a comprehensive analysis in a large pediatric cohort.
Purpose of the Study:
- To determine the prevalence of impaired kidney function in children after liver transplantation.
- To identify risk factors associated with post-LT kidney dysfunction in a pediatric population.
- To utilize measured glomerular filtration rate (mGFR) for accurate assessment of kidney function.
Main Methods:
- A cross-sectional study involving 397 pediatric patients from the Studies in Pediatric Liver Transplantation (SPLIT) registry.
- Measured glomerular filtration rate (mGFR) < 90 mL/min/1.73 m(2) was used as the primary outcome measure for kidney dysfunction.
- Data analysis included univariate and multivariate analyses to identify associated risk factors.
Main Results:
- At a mean of 5.2 years post-LT, 17.6% of patients exhibited impaired kidney function (mGFR < 90 mL/min/1.73 m(2)).
- Univariate analysis identified transplant center, age at LT, primary diagnosis, calculated GFR (cGFR) at LT and 12 months post-LT, primary immunosuppression, early post-LT kidney complications, age at mGFR, and height and weight Z-scores at 12 months post-LT as associated factors.
- Multivariate analysis revealed primary immunosuppression, age at LT, cGFR at LT, and height Z-score at 12 months post-LT as independent predictors of impaired kidney function.
Conclusions:
- Impaired kidney function is a significant concern in pediatric liver transplant recipients.
- Identifying specific risk factors like immunosuppression and pre-transplant kidney function is crucial for targeted interventions.
- This study provides valuable insights for improving long-term kidney outcomes in children following liver transplantation.
Abstract:
Impaired kidney function is a well-recognized complication following liver transplantation (LT). Studies of this complication in children have been limited by small numbers and insensitive outcome measures. Our aim was to define the prevalence of, and identify risk factors for, post-LT kidney dysfunction in a multicenter pediatric cohort using measured glomerular filtration rate (mGFR). We conducted a cross-sectional study of 397 patients enrolled in the Studies in Pediatric Liver Transplantation (SPLIT) registry, using mGFR < 90 mL/min/1.73 m(2) as the primary outcome measure. Median age at LT was 2.2 years. Primary diagnoses were biliary atresia (44.6%), fulminant liver failure (9.8%), metabolic liver disease (16.4%), chronic cholestatic liver disease (13.1%), cryptogenic cirrhosis (4.3%) and other (11.8%). At a mean of 5.2 years post-LT, 17.6% of patients had a mGFR < 90 mL/min/1.73 m(2) . In univariate analysis, factors associated with this outcome were transplant center, age at LT, primary diagnosis, calculated GFR (cGFR) at LT and 12 months post-LT, primary immunosuppression, early post-LT kidney complications, age at mGFR, height and weight Z-scores at 12 months post-LT. In multivariate analysis, independent variables associated with a mGFR <90 mL/min/1.73 m(2) were primary immunosuppression, age at LT, cGFR at LT and height Z-score at 12 months post-LT.
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