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Kidney Week

Abstract: FR-PO1172

Renal Recovery and Prognostic Factors in Children Following Liver Transplantation: A Single Center Experience

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Büscher, Rainer, University Hospital Essen, Essen, Germany
  • Gantenberg, Nicholas, University Hospital Essen, Essen, Germany
  • Storbeck, Tobias, University Hospital Essen, Essen, Germany
  • Büscher, Anja K., University Hospital Essen, Essen, Germany
  • Stopfkuchen, Henrike, University Hospital Essen, Essen, Germany
  • Hoyer, Peter F., University Hospital Essen, Essen, Germany
Background

Progression to chronic renal disease (CKD) is highly prevalent in adults following liver transplantation (LT) with a profound impact on patient survival, assuming that the prevalence of renal dysfunction is also considerably high in children. We report our experiences in a large paediatric transplant center and try to identify risk factors leading to a decline of renal function.

Methods


We retrospectively analyzed all 161 LT patients at our hospital from 2010 to 2017 (84 female). Medical records were reviewed for demographic, laboratory and clinical data. Patients were stratified into groups < 5 kg, 5-10 kg and > 10 kg. Change of renal function (slopes) was defined as loss/increase of GFR using the Schwartz formula and progress to renal failure within the first 4 weeks after LT was stratified according to the pRIFLE criteria. Mean observation time was 31 months (6 to 93 months).

Results


Out of 161 patients,134 were younger than 6 years at time of LT (74%). Average survival time in 5 years was 86%. CKD preexisted in 16 children (10%), nine undergoing dialysis before LT (5.5%). 7/145 proceeded to ESRD over 5 years (4.8%). Other patients developed pRIFLE I (21%), II (23%), III (11%) within the first 4 weeks after LT. Average GFR within 4 weeks after LT was lower in group <5kg (66 ml/min/1.73m2) compared to 81 (5-10 kg) and 114 (>10kg) ml/min/1.73m2. All GFR-slopes remained stable and were not significantly different from each other (<5kg: 0.01 vs. >5-10kg: 0,01 vs. >10kg: -0,35 ml/min/1,73m2/28 days). Within the entire observation time, all GFR-slopes showed a significant increase (<5kg: 14 vs. 5-10kg: 4 vs. >10kg: 3 ml/min/1.73m2/year). Regarding potential risk factors, 16 patients (10%) exceeded ABPM mean blood pressure values higher the 95th percentile, and 8 patients (5%) higher the 75th percentile. All other patients remained lower the 50th percentile. Albuminuria was rare (4%) and did not occur significantly more often in any subgroup. No independent risk factors for a decline of GFR to ESRD could be detected in all patients.

Conclusion

In contrast to adults, progress to ESRD in children following LT was rare (<5%) and most patients developed a normal GFR. Independent risk factors could not be defined. However, renal function, hypertension and proteinuria should be monitored regularly.