ESPN 50th Annual Meeting

ESPN 2017


 
Renal function after pediatric combined liver kidney transplantation
JESPER M. KIVELÄ 1 CHRISTER HOLMBERG 1 HANNU JALANKO 1 MIKKO P. PAKARINEN 2 JOUNI LAURONEN 3

1- PEDIATRIC NEPHROLOGY AND TRANSPLANTATION, CHILDREN’S HOSPITAL, HELSINKI UNIVERSITY HOSPITAL, HELSINKI, FINLAND
2- PEDIATRIC SURGERY, CHILDREN’S HOSPITAL, HELSINKI UNIVERSITY HOSPITAL, HELSINKI, FINLAND
3- THE FINNISH RED CROSS BLOOD SERVICE, HELSINKI, FINLAND
 
Introduction:

Combined liver and kidney transplantation (CLKT) is a viable option for end–stage organ failure altering both liver and kidney. Our aim was to evaluate renal function after pediatric CLKT with measured and estimated glomerular filtration rate (GFR). 

Material and methods:

All pediatric patients (age < 16 years) who underwent CLKT by 2011 were included (n=11). GFR was measured (mGFR) with 51Cr-EDTA clearance (n=10). In addition, GFR was estimated (eGFR) with bedside Schwartz equation [0.413 x (height (cm) / creatinine (mg/dL))] (n=10). GFRs are shown with unit of ml/min/1.73m2. Triple immunosuppression with cyclosporine or tacrolimus, azathioprine or mycophenolatemofetil and methylprednisolone was used. Results are shown with mean (SD). Paired t-test with 5000 bootstrap samples was used. In addition, comparison between eGFR and mGFR with limits of agreement (LOA) was made. 

Results:

Primary diagnoses for CLKT were autosomal recessive polycystic kidney disease (n=7), primary hyperoxaluria type I (n=2), methylmalonicacidemia (n=1) and atypical hemolytic uremic syndrome (n=1). Four (36.4%) patients were male. Mean age at CLKT was 4.9 (4.3) years. Mean mGFR at 1 year was 68.3 (24.0) [13.9 (2.6) months from CLKT] and 60.0 (11.6) at last follow-up [121.9 (47.1) months from CLKT]. Difference in mGFR between 1 year and last follow-up was 8.3 (95% CI - 6.1 to 26.5). Mean eGFR at 1 year was 82.1 (29.7) and 73.5 (18.3) at last follow-up. Difference in eGFR between 1 year and last-follow-up was 8.6 (95% CI - 6.6 to 21.6). Mean difference between eGFR and mGFR at 1 year was 13.8 (95% LOA - 46.8 to 74.4) and at last follow-up 13.5 (95% LOA - 10.4 to 37.5). 

Conclusions:

Renal function remained acceptable level in CLKT patients during the follow-up. Bedside Schwartz equation overestimated measured GFR, however, wide limits of agreement between these two methods justifies careful interpretation.