Long-term renal function in children after liver transplantation.

Area of Science:

• Pediatric Nephrology
• Transplantation Medicine
• Immunosuppression Management

Background:

• Reduced renal function is a significant long-term complication following pediatric liver transplantation (LT).
• Calcineurin inhibitor nephrotoxicity is a primary contributor to this post-transplant renal dysfunction.
• Long-term renal function surveillance is crucial for pediatric LT recipients.

Purpose of the Study:

• To evaluate long-term renal function in pediatric LT patients.
• To analyze the utility of various glomerular filtration rate (GFR) estimation methods in monitoring these patients.
• To identify factors influencing renal function decline after LT.

Main Methods:

• Inclusion of 57 pediatric patients undergoing LT.
• Serial measurement of GFR using 51-labeled chromium ethylenediaminetetraacetic acid clearance pre- and post-transplant.
• Correction of GFR with the modified Brochner-Mortensen equation and exclusion of outlier values.
• Analysis of GFR estimation methods (updated Schwartz, Schwartz 1987, Counahan-Barratt) against measured GFR.

Main Results:

• Mean GFR during follow-up was 76.0 mL/min/1.73 m2, with a significant decline observed between 5 and 7 years post-LT.
• The prevalence of stage 3 chronic kidney disease increased from 13% at 5 years to 33% at 15 years post-LT.
• Cyclosporine A trough levels and proteinuria were significant factors associated with renal function decline; GFR estimation methods showed varying degrees of overestimation compared to measured GFR.

Conclusions:

• Long-term renal function surveillance is essential for children following liver transplantation.
• While measured GFR is preferred, the updated Schwartz formula provides an acceptable estimation method for monitoring.
• Identifying and managing risk factors like immunosuppression and proteinuria is vital for preserving renal health post-LT.