RENAL-FUNCTION AND HISTOPATHOLOGIC CHANGES IN CHILDREN AFTER LIVER-TRANSPLANTATION

Up to 60% reduction of renal function has been reported after orthotop ic liver transplantation (OLT) in patients receiving cyclosporine. We prospectively investigated renal function and histopathology in 16 chi ldren on triple immunosuppression therapy during 3 years after OLT. Cy closporine was administered in 3 doses/day to preschool children. The median age at OLT was 5.4 years. Determinations of chromium 51-labeled ethylenediaminetetraacetic acid, p = aminohippuric acid, lithium, and sodium clearances, measurements of serum and urinary electrolytes, an d urinary concentration tests were performed. Renal biopsy specimens w ere taken 18 and 36 months after transplantation. The mean glomerular filtration rate was 121.5 ml/min per 1.73 m(2) before transplantation, 86.3 at discharge, and 119.4 36 months after OLT. Hyperuricemia, hype rkalemia, and reduced urinary concentrating capacity were common. Hype rkalemia occurred in 13% to 19% of the patients, only during the first 6 months. Hyperuricemia and reduced concentrating capacity occurred w ith incidences of 17% to 44% and 40% to 63%, respectively. Histopathol ogic changes were mild, and severe nephrotoxic effects of cyclosporine was not seen. However, tubular atrophy, mesangial matrix increase, an d mesangial cell proliferation were common. We conclude that triple im munosuppression with cyclosporine administration, in three doses per d ay, to small children and careful renal follow-up ensure good renal fu nction after OLT.