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Renal outcomes in pediatric liver transplantation
S M Bartosh1, E M Alonso, P F Whitington
1Department of Pediatrics, University of Chicago Pritzker School of Medicine, Illinois, USA.
Insights
Orthotopic liver transplantation in children can lead to significant long-term renal dysfunction. Approximately one-third of pediatric liver transplant recipients experience abnormal kidney function post-transplant.
Area of Science:
- Pediatric Nephrology
- Hepatology
- Transplantation Medicine
Background:
- Orthotopic liver transplantation (OLT) is a life-saving procedure for children with end-stage liver disease.
- Long-term outcomes, particularly renal function, following pediatric OLT require continued investigation.
Purpose of the Study:
- To retrospectively review the outcomes of pediatric orthotopic liver transplants.
- To assess the incidence and characteristics of renal dysfunction following OLT in children.
Main Methods:
- Retrospective review of 281 OLTs performed in 210 children between 1984 and 1992.
- Analysis of medical records, including renal function (calculated glomerular filtration rates), hypertension, and metabolic complications.
Main Results:
- 76% of pediatric liver transplant recipients were alive at follow-up.
- 6.2% experienced acute renal failure requiring dialysis (85% mortality).
- Abnormal renal function was observed in approximately one-third of children post-transplant, independent of various clinical factors.
Conclusions:
- Pediatric OLT is associated with a significant incidence of long-term renal dysfunction.
- Renal dysfunction post-OLT in children is a persistent issue, necessitating vigilant monitoring and further research into its causes and management.
Abstract:
The outcomes of 294 orthotopic liver transplants performed in 221 children at The University of Chicago Children's Hospital between October 1984 and October 1992 have been retrospectively reviewed. Medical information for 281 transplant in 210 children was sufficient for inclusion in this analysis. The mean age at transplant was 4.1 +/- 5.0 yr. Forty-four percent of the children were male, and 16% of the transplants were living-related. Four children received combined liver-kidney transplants. Seventy-six percent of the children are currently alive. The incidence of acute renal failure occurring following transplantation and requiring dialysis was 6.2% with a mortality rate of 85%. Early postoperative hypertension was seen in 65% of the children and persistent hypertension of greater than 12 months duration was seen in 28%. Sixteen percent of children developed metabolic acidosis requiring sustained sodium bicarbonate supplementation. Aggregate and longitudinal analysis of serial calculated glomerular filtration rates revealed abnormal renal function in approximately one third of children at any given time period following transplantation. The renal dysfunction was unrelated to age at transplant, type of transplant, gender, previous transplants, rejection episodes, courses of nephrotoxic drugs, presence of hypertension, or cyclosporin dose. This review supports prior studies which document abnormal renal function following orthotopic liver transplantation in a significant proportion of children.