Nephrotoxic Effects of Immunosuppressant Therapy in Pediatric Liver Transplant Recipients

McCulloch, Mignon; Burger, Hester; Spearman, Wendy; Cooke, Louise; Goddard, E.; Gajjar, Priya; Numanoglu, Alp; Rode, H.; Kahn, Delawir; Millar, Alastair J. W.

doi:10.1016/j.transproceed.2004.12.223

Cited by 10 publications

(14 citation statements)

References 11 publications

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“…Fifty percent of the 16 studies included in this review relied on the use of antihypertensive medications as evidence of hypertension, and 13% provided no definition 22, 23, 27, 33‐45. Estimates of the prevalence of hypertension from these studies vary from 4% to 100% (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

et al. 2012

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In long-term follow-up, 18-67% of pediatric liver transplant recipients are overweight or obese— with rates varying by age and pre-transplant weight status. Similar prevalence of post-transplant obesity is seen in adults. Adults also develop post-transplant metabolic syndrome, with consequent cardiovascular disease, at rates that exceed age and gender-matched populations. Post-transplant metabolic syndrome has never been studied in pediatric liver transplant recipients—a growing population as transplant outcomes continue to improve. This paper systematically reviews the literature on each component of metabolic syndrome—obesity, hypertension, dyslipidemia, and glucose intolerance—in pediatric liver transplant recipients. Rates of obesity are similar to that of the general U.S. population of children. But hypertension, dyslipidemia, and diabetes are more common than expected for age, gender, and obesity severity in transplant recipients. Immunosuppressive medications are major contributors. Limitations of prior studies—including heterogeneous methods of diagnosis, follow-up times, and immunosuppressive regimen—hinder the analysis of risk factors. Importantly, no studies report on graft or patient outcomes associated with metabolic syndrome components after pediatric liver transplant. However, if trends in children are similar to those seen in adults, these conditions may lead to significant long-term morbidity. Further research on the prevalence, causes, and consequences of post-transplant metabolic syndrome in pediatric liver transplant is needed and ultimately will help improve long-term outcomes.

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Section: Resultsmentioning

confidence: 99%

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

et al. 2012

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“…Hepatorenal syndrome before LT is an associated risk factor for renal insufficiency after transplantation . CNIs are felt to be the principal cause of de novo posttransplant renal dysfunction and factor in the progression of renal disease . Acquired renal cystic disease may occur after transplantation .…”

Section: Immunosuppressionmentioning

confidence: 99%

Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

et al. 2013

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“…These provide poor estimates of renal function, particularly in the pediatric population (3, 4, 10–13). Furthermore, many of the series in the literature include both children treated with ciclosporin and tacrolimus (5, 10, 14–18). Some adult studies have suggested that tacrolimus causes less reduction in renal blood flow and reduced impairment of renal function compared with ciclosporin (19–21), whereas others have shown no difference in long‐term renal function between the two calcineurin inhibitors (17, 22–24).…”

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confidence: 99%

Renal function evaluated by measured GFR during follow‐up in pediatric liver transplant recipients

Bishop

Burniston

Barnfield

et al. 2009

Pediatric Transplantation

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Calcineurin inhibitors form the mainstay of immunosuppression in pediatric liver transplantation, but may cause significant nephrotoxicity. We evaluated renal function in liver transplant recipients treated with a tacrolimus-based immunosuppressive regimen. GFR was measured using 99 mTc-DTPA in patients pretransplant and annually thereafter. GFR calculated by Schwartz formula was compared with the measured values. Sixty patients who underwent 69 transplants were followed for at least one yr post-transplant (median three yr). In children over two yr of age at transplant GFR fell significantly from pretransplant (140 mL/min/1.73 m(2)) to one yr post-transplant (112 mL/min/1.73 m(2)) (p = 0.01) but thereafter there was no significant decline. In younger children the picture was confounded by maturation of renal function, but again there was no significant fall to five yr post-transplant. Although 13 (22%) patients developed renal dysfunction post-transplant, none required renal replacement therapy. cGFR correlated poorly with measured values (r = 0.21). Use of a tacrolimus-based immunosuppressive regimen is associated with an initial decline in GFR, though this picture is confounded in younger children by normal maturation of renal function. There is no further significant fall in GFR in the medium-term. The Schwartz formula is inaccurate in determining GFR in this patient group.

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Nephrotoxic Effects of Immunosuppressant Therapy in Pediatric Liver Transplant Recipients

Cited by 10 publications

References 11 publications

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

Renal function evaluated by measured GFR during follow‐up in pediatric liver transplant recipients

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