Kidney Week

Abstract: SA-PO355

Renal Involvement After Pediatric Liver Transplantation: A Large Single-Center Cohort

Session Information

• Pediatric Nephrology - III
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Glass, Adi, Schneider Children's Medical Center of Israel Department of Internal Pediatrics A, Petah Tikva, Israel

Adi Glass,

• Goldberg, Ori J., Schneider Children's Medical Center of Israel Institute of Pulmonology, Petah Tikva, Israel

Ori J. Goldberg,

• Mozer Glassberg, Yael, Schneider Children's Medical Center of Israel Institute of Gastroenterology Nutrition and Liver Diseases, Petah Tikva, Israel

Yael Mozer Glassberg,

• Waisbourd-Zinman, Orith, Schneider Children's Medical Center of Israel Institute of Gastroenterology Nutrition and Liver Diseases, Petah Tikva, Israel

Orith Waisbourd-Zinman,

• Haskin, Orly, Schneider Children's Medical Center of Israel Institute of Nephrology, Petah Tikva, Israel

Orly Haskin,

• Levi, Shelly Shlomit, Schneider Children's Medical Center of Israel Institute of Nephrology, Petah Tikva, Israel

Shelly Shlomit Levi,

• Landau, Daniel, Schneider Children's Medical Center of Israel Institute of Nephrology, Petah Tikva, Israel

Daniel Landau,

• Alfandary, Hadas, Schneider Children's Medical Center of Israel Institute of Nephrology, Petah Tikva, Israel

Hadas Alfandary,

Background

Survival after pediatric liver transplantation has increased dramatically over the years, revealing extra-hepatic complications including impaired renal function. We conducted a large single center retrospective study to evaluate thoroughly renal outcomes after pediatric liver transplantation.

Methods

Pre and post-transplant data was collected from electronic charts of children who underwent liver transplantation at SCMCI from 2007-2020. Incidence of renal injury which included proteinuria, hypertension or decreased eGFR was documented. Additional renal assessment by renal ultrasound and the presence of acute kidney injury (AKI) was performed. Predictors for hypertension or decreased eGFR at last follow-up were identified using univariate and multivariate regression models.

Results

121 children were followed for a median of 5.12 (IQR 2.94-7.3) years. After excluding 18 patients who died, or underwent renal transplantation, any renal injury was observed in 33.9% of the children, hypertension: 12.6%, proteinuria: 23.3%, and eGFR<90 mL/min per 1.73 m²: 6.7% at their last follow-up. Reduction in eGFR was observed along the follow-up, and was accentuated in the first year post transplant (figure 1). AKI was seen in 41.7% of the children during follow-up. An abnormal renal ultrasound was seen in 44.7% of the children at last visit, significantly higher rates than before transplant, 10.7% (p<0.001). Abnormal renal ultrasound before transplant (OR=4.49, 95% CI 1.1-18.3) and liver disease with risk of renal involvement (OR=4.32, 95% CI 1.4-13.0) were found to be predictors for hypertension or decreased GFR at last follow-up.

Conclusion

Renal injury is very common in children after pediatric liver transplantation. Therefore, thorough renal pretransplant evaluation and follow-up are necessary for preserving and improving renal function.

*P< 0.05 Liver disease with renal involvement versus without. LT, liver transplant.