We report the results of a study of survival, liver and kidney functions, and growth with a median follow-up of 24 years following liver transplantation in childhood. From 1988 to 1993, 128 children underwent deceased donor liver transplantation (median age: 2.5 years). Twenty-year patient and graft survival rates were 79% and 64%, respectively. Raised serum aminotransferase and/or γ-glutamyl transferase activities were present in 42% of survivors after a single transplantation. Graft histology (35 patients) showed signs of chronic rejection in 11 and biliary obstruction in 5. Mean total fibrosis scores were 4.5/9 and 3/9 in patients with abnormal and normal serum liver tests, respectively. Glomerular filtration rate was <90 mL·min in 35 survivors, including 4 in end-stage renal disease who were undergoing dialysis or had undergone renal transplantation. Median final heights were 159 cm for women and 172 cm for men; final height was below the target height in 37 patients. Twenty-year survival after childhood liver transplantation may be close to 80%, and final height is within the normal range for most patients. However, chronic kidney disease or altered liver biochemistries are present in over one third of patients, which is a matter of concern for the future.

Two groups of rats, one with surgically induced chronic renal failure and a sham-operated group were used. 10 weeks after surgery the animals were individually mated for 15 days according to 4 different schemes: uremic couple, control couple, a couple with a uremic male, and a couple with a uremic female. A second mating was allowed 18 weeks after surgery. There the uremic rats and nonfertile controls were matched against fertile controls. The experimental group showed a higher percentage of nonfertile rats, their offspring had fewer newborns and the uremic mothers had litters that weighed less at birth. In uremic males low plasma testosterone levels were detected. The analysis of plasma luteinizing hormone in the female and the delayed fertilization of uremic mothers suggest the presence of irregularities in the estrous cycle of uremic females.