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Related Experiment Videos

Serial decrease in glomerular filtration rate in long-term pediatric liver transplantation survivors treated with

S V McDiarmid1, R B Ettenger, R N Fine

  • 1Department of Pediatric Gastroenterology, UCLA School of Medicine, Los Angeles, CA 90024.

Transplantation
|February 1, 1989
PubMed
Summary

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Pediatric liver transplant patients on Cyclosporine A (CsA) show significant, progressive decline in kidney function (glomerular filtration rate) over time. Over half experienced renal impairment, with no link to CsA dosage or blood levels.

Area of Science:

  • Nephrology
  • Pediatric Gastroenterology
  • Transplantation Medicine

Background:

  • Cyclosporine A (CsA) is a key immunosuppressant post-liver transplantation.
  • Long-term effects of CsA on renal function in pediatric liver transplant recipients require further investigation.

Purpose of the Study:

  • To assess serial changes in glomerular filtration rate (GFR) in pediatric liver transplant recipients receiving CsA.
  • To identify risk factors and prevalence of renal impairment in this population.

Main Methods:

  • Serial calculation of calculated GFR (cGFR) using the Schwartz formula in 31 pediatric liver transplant recipients surviving over 1 year.
  • Monitoring of cGFR, CsA dose/kg, CsA levels, blood pressure, and liver function at 3-6 month intervals pre- and post-orthotopic liver transplantation (OLT).

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Main Results:

  • A significant mean decrease in cGFR of -50 ml/min/1.73 m2 was observed post-OLT (P < 0.005).
  • 55% of patients (17/31) exhibited a cGFR < 80 ml/min/1.73 m2, indicating renal impairment.
  • Progressive cGFR decline occurred in 24 patients, averaging 26.8 ml/min/1.73 m2 per year (P < 0.005).
  • Hypertension was more prevalent in patients with cGFR < 80 ml/min/1.73 m2.
  • No correlation was found between cGFR and CsA levels, CsA dose, or liver function.

Conclusions:

  • Pediatric liver transplant recipients on CsA for over 1 year experience significant and progressive renal function decline.
  • Renal impairment is common and appears independent of CsA dosage or blood levels.
  • Close monitoring of renal function is crucial in these patients.