Acquired renal cysts after pediatric liver transplantation: association with cyclosporine and renal dysfunction.
ACKD has been observed in children on dialysis and with chronic renal insufficiency. In one report, ACKD was observed in 30% of pediatric liver transplant recipients after 10 yr. We retrospectively reviewed all renal imaging and measurements of GFR of 235 childhood liver transplant recipients with no known risk for renal cyst formation, no evidence of renal cyst(s) at the time of transplantation and renal imaging at least one yr post-transplant. Twenty-six patients (11%) developed one or more cyst(s). Mean GFR was significantly lower in patients with renal cyst(s). Two (1.4%) of the 146 patients treated with tacrolimus and 24 (27%) of the 89 patients treated with CsA acquired renal cyst(s) (p < 0.001). CsA-treated patients had significantly lower GFR. Multivariate analysis identified CsA as the only independent variable associated with ACKD. These results confirm that ACKD can be a late complication of pediatric liver transplantation. Those at most risk are at least 10-yr post-liver transplantation, have been treated with CsA and have impaired renal function. We speculate that ACKD in these patients is the result of calcineurin inhibitor nephrotoxicity. Whether patients with ACKD will be prone to develop solid renal tumors is unknown.
Calvo-Garcia
M A
MA
Department of Pediatric Radiology and Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnata, Cincinnata, OH 45229, USA.
Campbell
K M
KM
O'Hara
S M
SM
Khoury
P
P
Mitsnefes
M M
MM
Strife
C F
CF
D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007674:Kidney Diseases / Q000188:drug therapy*; D052177:Kidney Diseases, Cystic / Q000209:etiology* / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine