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Reuters Health Information (2006-05-29): Renal dysfunction common after pediatric liver transplantation


Renal dysfunction common after pediatric liver transplantation

Last Updated: 2006-05-29 13:40:23 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Renal dysfunction is common in long-term survivors of pediatric liver transplantation, according to a report in the April issue of The Journal of Pediatrics.

"As post-transplant survival increases, long-term complications such as this are becoming more important contributors to morbidity and mortality," Dr. Kathleen M. Campbell from Cincinnati Children's Hospital Medical Center, Ohio told Reuters Health. "Both transplant professionals and primary care physicians alike must be aware of the potential for post-transplant renal dysfunction, so that we can work together to ensure early recognition and avoid additional renal damage."

Dr. Campbell and colleagues investigated the prevalence of chronic renal dysfunction in 117 children who were long-term survivors of liver transplantation.

After a mean follow-up time of 7.6 years, the authors report, nearly a third of the patients (37 patients, 31.6%) had measured GFR below 70 mL/min per 1.73 square meters of body surface area.

Forty-two of 104 patients who had blood pressure recorded were greater than the 95th percentile for age and sex-matched control patients, the results indicate, and 12 of these were receiving antihypertensive medication. One year after transplant, 62 patients met the authors' definition for elevated blood pressure.

In a univariate analysis, primary immunosuppression with cyclosporine, increased time since transplant, and lower measured GFR 1 year after transplant were significantly associated with a measured GFR < 70 mL/min/1.73 square meters at last follow-up. Elevated blood pressure at 1 year was associated with measured GFR of at least 70 mL/min/1.73 meters squared at last follow-up.

"The association of elevated blood pressure at 1 year after transplant with normal long-term renal function was unexpected," the investigators write. "Perhaps this relationship reflected the inclusion of patients receiving antihypertensive medications, which may provide some long-term renal protection."

Cyclosporine use was associated with more than a 10-fold increased odds of long-term renal dysfunction after adjustment for other variables, the report indicates.

"The long-term health and quality of life of our patients demand that we identify strategies that will mitigate, and even prevent, renal dysfunction following pediatric liver transplantation," Dr. Campbell said. "Potential interventions deserving of investigation include aggressive control of hypertension and proteinuria, early use of ACE inhibitors, and use of individualized immunosuppression regimens."

J Pediatr 2006;148:475-480.

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