Premium
The kidney in pediatric liver transplantation: An updated perspective
Author(s) -
Matloff Robyn Greenfield,
Ar Ronen,
Saland Jeffrey M.
Publication year - 2012
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12006
Subject(s) - medicine , liver transplantation , proteinuria , nephrotoxicity , intensive care medicine , renal function , transplantation , population , pediatrics , kidney , environmental health
CKD continues to detract from the success of improved survival in pediatric liver transplantation, and its presence is likely under recognized. Here we review the literature regarding the prevalence, etiology, and management of renal dysfunction in pediatric liver transplant recipients. Long‐term studies suggest the prevalence of CKD to be 25–38% by 5–10 yr post‐transplant. While important, sole use of serum creatinine overestimates renal function in this population. Screening for and treatment of persistent proteinuria and hypertension as well as minimization of nephrotoxic insults are the mainstays to delay or prevent CKD progression. Office‐based blood pressure measures are less sensitive than ABPM , which is specifically recommended by the American Heart Association for its ability to diagnose masked hypertension in pediatric liver transplant recipients. Long‐term risk of CKD is predominantly secondary to CNI toxicity. CNI minimization protocols have shown promise in slowing progression of CKD while maintaining graft function, but large‐scale randomized control trials with long‐term follow‐up are needed.