SENSORINEURAL HEARING-LOSS IN CHILDREN AFTER LIVER-TRANSPLANTATION

Objective: To investigate risk factors for sensorineural hearing loss (SNHL) in children after liver transplantation. Design: Retrospective medical record review. Setting: Pediatric tertiary: care hospital. Pat ients: One hundred twenty-five consecutive children who received liver transplants between March 1, 1987, and June 30, 1996. Main Outcome Me asures: The presence of SNHL (bone conduction threshold of >35 dB of h earing loss in at least 1 frequency) and the cause of the liver abnorm ality in all 125 patients. Tn addition, among the subset of children w ho had biliary atresia and underwent transplantation before 2 years of age, the total dose (milligrams per kilogram of body weight) of amino glycoside antibiotic medications (tobramycin sulfate, gentamicin sulfa te, and amikacin sulfate) and of intravenous loop diuretic agents (fur osemide) was compared between children with and without SNHL. Results: Audiologic evaluations were available for 66 of 125 patients, 15 (12% ) of whom have SNHL. Of 5 survivors with the short-bowel syndrome, 4 h ave severe to profound SNHL. Of 46 children who have biliary atresia a nd who underwent transplantation before 2 years of age, 8 (17%) have S NHL. Among the 26 evaluable children with biliary atresia undergoing l iver transplantation before 2 years of age, logistic regression analys is revealed that the most important risk factor for SNHL was the cumul ative dose of amikacin (P = .05). Conclusions: Children receiving live r transplants are at an increased risk for SNHL. Those with the short- bowel syndrome have the greatest prevalence of SNHL. Among the subset of children with biliary atresia receiving liver transplants before 2 years of age, statistical analysis demonstrates a dose-response relati onship between the receipt of amikacin and the occurrence of SNHL.