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Review
. 2020 Nov;34(11):e14082.
doi: 10.1111/ctr.14082. Epub 2020 Sep 28.

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Antonio Lacquaniti  1 , Susanna Campo  1 , Teresa Casuscelli Di Tocco  1 , Stefania Rovito  1 , Maurizio Bucca  1 , Antonino Ragusa  1 , Paolo Monardo  1
Affiliations
Review

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Antonio Lacquaniti et al. Clin Transplant. 2020 Nov.

Abstract

Acute and chronic kidney injuries represent critical issues after liver transplantation (LTx), but whereas renal dysfunction in adult transplant patients is well documented, little is known about its prevalence in childhood. It is a challenge to accurately evaluate renal function in patients with liver disease, due to several confounding factors. Creatinine-based equations estimating glomerular filtration rate, validated in nephropathic patients without hepatic issues, are frequently inaccurate in end-stage liver disease, underestimating the real impact of renal disease. Moreover, whereas renal issues observed within 1 year from LTx were often related to acute injuries, kidney damage observed after 5-7 years from LTx, is due to chronic, irreversible mechanisms. Most immunosuppression protocols are based on calcineurin inhibitors (CNIs) and corticosteroids, but mycophenolate mofetil or sirolimus could play significant roles, also in children. Early diagnosis and personalized treatment represent the bases of kidney disease management, in order to minimize its close relation with increased mortality. This review analyzed acute and chronic kidney damage after pediatric LTx, also discussing the impact of pre-existent renal disease. The main immunosuppressant strategies have been reviewed, highlighting their impact on kidney function. Different methods assessing renal function were reported, with the potential application of new renal biomarkers.

Keywords: calcineurin inhibitors; chronic kidney disease; nephrotoxicity; pediatric liver transplantation; renal biomarkers; renal function estimation.

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References

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