Long-term kidney function affected after pediatric liver transplantation
Decline in renal function can be seen up to 15 years after transplantation, according to data presented at the 6th World Congress of Paediatric Gastroenterology, Hepatology and Nutrition, which highlighted the importance of long-term surveillance in patients who undergo transplantation regardless of rejection.
In this retrospective study, 346 cases of pediatric liver transplant, 145 with rejection and 201 with non-rejection, were reviewed. In the non-rejection group, indications for liver transplantation included biliary atresia, acute liver failure, hepatoblastoma, and autoimmune liver disease. In the rejection group, indications included biliary atresia, acute liver failure, hepatoblastoma, and autoimmune liver disease.
In the first 3 months after transplantation, the estimated glomerular filtration rate decreased 21.8% but kidney function recovered by 1 year.
At 5 years after transplant, 25 children from the rejection group and 17 from the non-rejection group had chronic kidney disease (38 had stage 2, 3 had stage 3a, and 1 had stage 3b). By 10 years after transplant, stage 2 chronic kidney disease was resolved in 9 patients and remained in 4 in the rejection group; 12 were transitioned or lost to follow-up. In the non-rejection group at 10-year follow-up, stage 2 chronic kidney disease was resolved in 6 patients. By 15 years post transplants, the patient with stage 3a had improved to stage 2.
By 15 years post-transplantation, both groups experienced further decline, which the researchers possibly attributed to the related long-term effects of immunosuppression.
Kam CC, et al. Long term kidney function is significantly affected in children following paediatric liver transplantation irrespective of increased immunosuppression following episodes of rejection. Presented at: 6th World Congress of Paediatric Gastroenterology, Hepatology and Nutrition.