Renal Assessment in the Setting of Pediatric Living Related Liver Transplantation
Authors: Abdel Ghaffar Tawhida Yassin , Ali Said Ragia Marei , Mohamed Noha Refaat , Shaker Shenouda Marianne Atef 
Published: July 2024

Abstract

Background
Liver transplantation in the pediatric age group has become the last resort and yet the preferred option for many end stage liver disorders. This field shows a great improvement and is considered a breakthrough achievement for previously fatal liver diseases. Renal functions are not thoroughly studied in pediatric patients undergoing liver transplantation.

Aim of the Work
To determine the prevalence and risk factors of renal dysfunction among pediatric living related liver transplantation (LRLT).

Patients and Methods
This was a cross sectional retrospective and prospective cohort study in which a pilot study for a six-month duration is estimating the incidence of renal dysfunction among LRLT. A total of 40 patients were enrolled during the duration of the study from Ain Shams University, pediatric hospital and Dr. Yassin Abdel Ghaffar charity center for liver disease and research. Full history and clinical examination was performed as well as base line investigations preoperatively including: Serum Creatinine, Urea, Na, K, PO4, Ca, corrected creatinine clearance and urine analysis. Post-operative assessment was done to same parameters in addition to: Serum Mg, Cl, HCO, uric acid, drug trough level of used immunosuppressive drugs, 24 hours’ urinary proteins, and 24 hours’ assessment of electrolytes (Na, K, Ca, PO4, HCO3) in case of lowered serum levels. Moreover, pre and postoperative pelviabdominal U/S to check kidney status (size, echogenicity, RI of renal arteries) was assessed.

Results
Forty patients were analyzed of which 70% of the patients were males. The mean age at transplantation was 6.84±3.3 years. The commonest diagnosis of the studied group was high gamma-glutamyl transferase (GGT) cholestasis (35%) followed by Biliary atresia (22.5%). Of the enrolled patients, 50% were CHILD-B score, the median of the CHILD Score prior to transplantation was 8 and the median of the PELD score was 7.4. 87.5% of the patients had normal urine analysis, and normal proteinuria in 100% of the patients. The postoperative laboratory investigations were within the normal ranges. Mg was low in 67% of patients while Ca was low in 42.5%.The mean of creatinine, K and Ca levels are significantly elevated after LT (P &lt; 0.05). After a mean duration since transplantation of 4 years, we found that 82.5% of our patients were CKD G1. S. creatinine was positively correlated with the patient age, duration of transplantation, s. uric acid, and average Fk level over the past year(P &lt; 0.05 for all).

Conclusion
Renal dysfunction is a common, yet may be an underestimated, problem after pediatric liver transplant. Renal impairment was limited in our patients probably due to favorable perioperative conditions. Our pediatric recipients require mandatory and planned nephrologic evaluation to early detect any renal impairment which may develop into an end-stage renal disease and eventually increase the patient mortality rate. Further studies with larger cohort of patients and more advanced methods of assessment of renal functions are recommended.