RENAL OUTCOMES IN PEDIATRIC LIVER-TRANSPLANTATION

The outcomes of 294 orthotopic liver transplants performed in 221 chil dren at The University of Chicago Children's Hospital between October 1984 and October 1992 have been retrospectively reviewed. Medical info rmation for 281 transplants in 210 children was sufficient for inclusi on in this analysis. The mean age at transplant was 4.1 +/- 5.0 yr. Fo rty-four percent of the children were male, and 16% of the transplants were living-related. Four children received combined liver-kidney tra nsplants. Seventy-six percent of the children are currently alive. The incidence of acute renal failure occuring following transplantation a nd requiring dialysis was 6.2% with a mortality rate of 85%. Early pos toperative hypertension was seen in 65% of the children and persistent hypertension of greater than 12 months duration was seen in 28%. Sixt een percent of children developed metabolic acidosis requiring sustain ed sodium bicarbonate supplementation. Aggregate and longitudinal anal ysis of serial calculated glomerular filtration rates revealed abnorma l renal function in approximately one third of children at any given t ime period following transplantation. The renal dysfunction was :unrel ated to age at transplant, type of transplant, gender, previous transp lants, rejection episodes, courses of nephrotoxic drugs, presence of h ypertension, or cyclosporin dose. This review supports prior studies w hich document abnormal renal function following orthotopic liver trans plantation in a significant proportion of children.