High prevalence of renal dysfunction in long-term survivors after pediatric liver transplantation.
OBJECTIVE
To determine the prevalence and identify variables associated with renal dysfunction in long-term survivors of pediatric liver transplantation.


METHODS
Data from 117 patients who survived>or=3 years after liver transplantation were analyzed. Demographic and clinical information was obtained from chart review and from a clinical care database. The dependent variable was renal function as determined by measured glomerular filtration rate (mGFR). Univariate and multivariate analyses were performed to identify independent variables associated with renal dysfunction (mGFR<70 mL/min per 1.73 m2).


RESULTS
The average time since liver transplant was 7.6+/-3.4 years (range, 3 to 14.6 years). When the last available mGFR for all patients was analyzed, renal dysfunction was present in 32%. In the univariate analysis, mGFR at 1 year after transplant, cyclosporine immunosuppression, and time since transplant were significant; the second two were strongly collinear. Using multiple logistic regression modeling excluding time since transplant, cyclosporine and mGFR at 1 year after transplant were strongly associated with renal dysfunction.


CONCLUSIONS
Renal dysfunction is a common complication in children who survive liver transplantation. Our observations are of critical importance because children may live long enough to move from a stage of renal insufficiency characterized by asymptomatic decreased GFR to symptomatic end-stage renal disease.
Campbell
Kathleen M
KM
Pediatric Liver Care Center, Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, OH 45229, USA. kathleen.campbell@cchmc.org
Yazigi
Nada
N
Ryckman
Frederick C
FC
Alonso
Maria
M
Tiao
Greg
G
Balistreri
William F
WF
Atherton
Harry
H
Bucuvalas
John C
JC
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine