title: Long-term renal function in children after liver transplantation.
abstract: BACKGROUND
  Reduced renal function after liver transplantation (LT) is a long-term extrahepatic complication of major concern caused at least partly by calcineurin inhibitor nephrotoxicity. We report on long-term renal function after LT in children from a single center and analyze the usefulness of glomerular filtration rate (GFR) estimation methods in the follow-up of pediatric LT patients.
  
  
  METHODS
  Fifty-seven pediatric patients were included. GFRs were measured by 51-labeled chromium ethylenediaminetetraacetic acid clearance before LT, at discharge, 6, 12, 18, and 24 months after transplantation and annually thereafter and corrected with the modified Brochner-Mortensen equation. GFR values of cases with an ethylenediaminetetraacetic acid distribution volume less than 15% or more than 35% were excluded.
  
  
  RESULTS
  The mean GFR for overall follow-up was 76.0 mL/min/1.73 m2 (+/-22.2 mL/min/1.73 m2). The GFR declined significantly from 5 to 7 years (80.2 [+/-17.7] to 72.9 [+/-13.3] mL/min/1.73 m2, respectively; P<0.05). Thirteen percent, 21%, 31%, and 33% of patients had stage 3 chronic kidney disease at 5, 7, 10, and 15 years after LT, respectively. The cyclosporine A trough level was a significant time-dependent factor in the regression model, and after time was removed from the model, proteinuria was the most significant factor. GFR estimation methods overestimated measured GFR; 11% with updated Schwartz, 50% with Schwartz 1987, and 31% with Counahan-Barratt.
  
  
  CONCLUSIONS
  This study underlines the importance of long-term renal function surveillance after LT performed on children. Although measuring GFR remains the preferred function surveillance method, the updated Schwartz formula is also acceptable.
authors: Department of Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors: Jesper M
authors: JM
authors: Kivelä
authors: Anne
authors: A
authors: Räisänen-Sokolowski
authors: Mikko P
authors: MP
authors: Pakarinen
authors: Heikki
authors: H
authors: Mäkisalo
authors: Hannu
authors: H
authors: Jalanko
authors: Christer
authors: C
authors: Holmberg
authors: Jouni
authors: J
authors: Lauronen
mesh_terms: D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008991:Monitoring, Physiologic; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine