Abstract | BACKGROUND: Renal impairment is a frequent complication after orthotopic liver transplantation (OLT). However, most studies in children use inaccurate renal assessment based on serum creatinine, and long-term follow-up data are lacking. The purpose of this study was to determine incidence, determinants, and progression of long-term chronic renal insufficiency (CRI) in a single-center series of pediatric liver transplant recipients. METHODS: The true glomerular filtration rate was measured by inulin clearance before and serially after OLT in 69 consecutive patients followed more than 2 years after transplantation. Cumulative incidence of CRI (glomerular filtration rate<60 mL/min/1.73 m2) was determined using a Kaplan-Meier method. A Cox proportional hazard model was performed to identify predictors of CRI. RESULTS: The median age at OLT was 3.2 years. The median follow-up time after OLT was 9.3 years (interquartile range 6.3-11.9). At 10 years post-OLT, the cumulative incidence of CRI was 25%. In a multivariate Cox regression model, arterial hypertension during follow-up as time dependant variable (P=0.03), cyclosporine as primary immunosuppression (P=0.048), and liver diseases with potential renal involvement including inborn errors of metabolism, Alagille syndrome, and hepatic fibrosis (P=0.003) were associated with CRI. CONCLUSIONS: Renal function is a major concern long after OLT in children. Renal dysfunction post-OLT may be reduced by optimal control of arterial hypertension, immunosuppression protocols adapted to primary liver disease, and calcineurin inhibitor sparing regimen.
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Authors | Jérôme Harambat, Bruno Ranchin, Laurence Dubourg, Aurélia Liutkus, Aoumeur Hadj-Haïssa, Christine Rivet, Olivier Boillot, Alain Lachaux, Pierre Cochat |
Journal | Transplantation
(Transplantation)
Vol. 86
Issue 8
Pg. 1028-34
(Oct 27 2008)
ISSN: 1534-6080 [Electronic] United States |
PMID | 18946339
(Publication Type: Journal Article)
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Chemical References |
- Immunosuppressive Agents
- Cyclosporine
- Inulin
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Topics |
- Adolescent
- Adult
- Child
- Child, Preschool
- Cyclosporine
(adverse effects)
- Disease Progression
- Female
- Follow-Up Studies
- Glomerular Filtration Rate
- Humans
- Hypertension
(complications)
- Immunosuppressive Agents
(adverse effects)
- Incidence
- Infant
- Inulin
- Kaplan-Meier Estimate
- Liver Diseases
(complications)
- Liver Transplantation
(adverse effects)
- Male
- Proportional Hazards Models
- Renal Insufficiency, Chronic
(diagnosis, epidemiology, etiology, physiopathology)
- Risk Assessment
- Risk Factors
- Severity of Illness Index
- Survivors
- Time Factors
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