Korean J Transplant.  2021 Oct;35(Supple 1):S123. 10.4285/ATW2021.OR-1286.

Favorable long-term renal outcome following pediatric liver transplantation

• Hong SY
• Yi N
• Yoo BM
• Hong SK
• Ahn YH
• Kang HG
• Choi Y
• Lee KW
• Suh KS

• KMID: 2521353
• DOI: http://doi.org/10.4285/ATW2021.OR-1286

Abstract

Background
Renal dysfunction is one of the critical issues of long-term outcome after liver transplantation (LT). Post-transplant renal function in adult transplant patients is well described, however, little is known about its prevalence in pediatric transplant patients.
Methods
From March 1999 to May 2016, 225 recipients underwent pediatric LT in Seoul National University Hospital. Patients with follow-up period less than 3 months or preoperative chronic kidney disease (CKD) were excluded. Cumulative incidence of CKD (defined as a glomerular filtration rate of 60 mL/min/1.73 m 2 of body-surface area or less or the development of end-stage renal disease) was determined using a Kaplan-Meier method.
Results
The median age at LT was 2 years (range, 0.2–17 years). During a median follow-up of 150 months, CKD developed in nine patients (4.41%). Of these patients, three patients underwent renal transplantation. The 1-, 5-, 10-year renal survival with CKD as the event was 99%, 97.9%, and 96.1%, respectively. In the adult group who received LT during the same period, The 1-, 5-, 10-year renal survival was 96.2%, 85.6%, and 79.4%, respectively, which showed significant difference compared to pediatric group (P<0.001). In a multivariate Cox regression model, hepatic artery thrombosis (P<0.0001) and primary liver diseases with potential renal involvement (P=0.033) were associated with CKD.
Conclusions
Renal function can be highly preserved following pediatric LT even in the long-term period, which is distinct finding from adult LT patients. However, more attention should be paid to patients with hepatic artery thrombosis and primary liver diseases with potential renal involvement to better improve renal outcome after pediatric LT.