Risk Factors for End-Stage Kidney Disease After Pediatric Liver Transplantation

Ruebner, Rebecca L.; Reese, Peter P.; Rand, Elizabeth B.; Abt, Peter L.; Furth, Susan L.

doi:10.1111/j.1600-6143.2012.04270.x

Cited by 31 publications

(40 citation statements)

References 45 publications

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“…Children with CKD face many complications including hypertension, dyslipidemia, cardiovascular disease, anemia, bone disease, growth retardation, neurocognitive impairment, and poor quality of life. 4,5,[19][20][21][22][23][24][25] Our analysis identifies a high-risk population for ESKD; targeting renoprotective interventions to these children in earlier stages of kidney disease may decrease CKDrelated morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…CKD, and in particular end-stage kidney disease (ESKD), is associated with significant morbidity and increases the risk of death after SOT. [4][5][6] Evaluating the incidence of ESKD after pediatric SOT is of critical importance to help guide clinicians in identifying children at highest risk and monitoring those patients for early signs of kidney disease. Early identification of CKD may allow implementation of measures to slow progression to or possibly prevent ESKD.…”

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confidence: 99%

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End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: End-stage kidney disease (ESKD) causes significant morbidity and mortality after solid organ transplantation. Adults commonly develop advanced kidney disease, particularly after liver and intestinal transplantation. Previous pediatric studies have not compared the relative incidence of ESKD by organ type. WHAT THIS STUDY ADDS:This national cohort study shows the highest risk of ESKD among pediatric lung and intestinal transplant recipients, reflecting unique organ-specific causes of kidney injury. Our findings have implications for screening for and treating early kidney disease in transplant recipients. abstract OBJECTIVES: Adult solid organ transplant (SOT) recipients commonly develop advanced kidney disease; however, the burden of end-stage kidney disease (ESKD) in children after SOT is not well-described. The objectives of this study were to determine the incidence of ESKD after pediatric SOT and the relative risk by SOT type. METHODS:Retrospective multicenter cohort study of children, ages #18 years, who received SOTs from 1990 through 2010 using Scientific Registry of Transplant Recipients data linked to the US Renal Data System. We performed a competing risks analysis to determine cumulative incidence of ESKD (chronic dialysis or kidney transplant), treating death as a competing risk, and fit a multivariable Cox regression model to assess hazard of ESKD by organ type. RESULTS:The cohort included 16 604 pediatric SOT recipients (54% liver, 34% heart, 6% lung, 6% intestine, and 1% heart-lung). During a median follow-up of 6.2 years (interquartile range 2.2-12.1), 426 (3%) children developed ESKD. Compared with liver transplant recipients, in whom the incidence of ESKD was 2.1 cases per 1000 person-years, in adjusted analyses the highest risk of ESKD was among intestinal (hazard ratio [HR] 7.37, P , .001), followed by lung (HR 5.79, P , .001) and heart transplant recipients (HR 1.79, P , .001). CONCLUSIONS:In a 20-year national cohort of pediatric SOT recipients, the risk of ESKD was highest among intestinal and lung transplant recipients. The burden of earlier stages of chronic kidney disease is probably much higher; modifiable risk factors should be targeted to prevent progressive kidney damage in this high-risk population.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

et al. 2013

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“…22, 24–26, 28 Direct acting antiviral agents (DAA) have revolutionized the treatment of hepatitis C over the last four years, especially in post-LT setting. 49–51 Prior to approval of these DAA’s, the sustained virological response of antiviral therapy with pegylated interferon and ribavirin varied from 20%–45%.…”

Section: Treatment Of Hepatitis Cmentioning

confidence: 99%

Chronic Kidney Disease and Related Long-Term Complications After Liver Transplantation

Sharma¹,

Bari²

2015

Advances in Chronic Kidney Disease

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Liver transplantation (LT) is the standard of care for patients with decompensated cirrhosis. LT recipients have excellent short-term and long-term outcomes including patient and graft survival. Since the adoption of model for end-stage liver disease (MELD) - based allocation policy, the incidence of post-transplant end stage renal disease has risen significantly. Occurrence of stage 4 chronic kidney disease and end stage renal disease substantially increase the risk of post-transplant deaths. Since majority of late post-transplant mortality is due to non-hepatic post-transplant comorbidities, personalized care directed towards risk factor modification may further improve post-transplant survival.

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“…Those covariates with P#0.05 were included in the final model. The following baseline covariates determined at the time of LTwere included in model selection based on these data and previous studies: 2,5,18,19 recipient age, sex, race, diagnosis, BMI, status-1 (acute liver failure), pre-LT hypertension, diabetes mellitus, hospitalization status at LT, on life support at LT, on RRT at LT, previous LT, history of TIPSS, serum bilirubin, serum creatinine, slope of creatinine, acute dialysis, INR, serum sodium, and serum albumin.…”

Section: Model Buildingmentioning

confidence: 99%

Patient-Specific Prediction of ESRD after Liver Transplantation

Sharma¹,

Goodrich

Schaubel³

et al. 2013

Journal of the American Society of Nephrology

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Incident ESRD after liver transplantation (LT) is associated with high post-transplant mortality. We constructed and validated a continuous renal risk index (RRI) to predict post-LT ESRD. Data for 43,514 adult recipients of deceased donor LT alone (February 28, 2002 to December 31, 2010 were linked from the Scientific Registry of Transplant Recipients and the Centers for Medicare and Medicaid Services ESRD Program. An adjusted Cox regression model of time to post-LT ESRD was fitted, and the resulting equation was used to calculate an RRI for each LT recipient. The RRI included 14 recipient factors: age, AfricanAmerican race, hepatitis C, cholestatic disease, body mass index$35, pre-LT diabetes, ln creatinine for recipients not on dialysis, ln albumin, ln bilirubin, serum sodium,134 mEq/L, status-1, previous LT, transjugular intrahepatic portosystemic shunt, and acute dialysis at LT. This RRI was validated and had a C statistic of 0.76 (95% confidence interval, 0.75 to 0.78). Higher RRI associated significantly with higher 5-year cumulative incidence of ESRD and post-transplant mortality. In conclusion, the RRI constructed in this study quantifies the risk of post-LT ESRD and is applicable to all LT alone recipients. This new validated measure may serve as an important prognostic tool in ameliorating post-LT ESRD risk and improve survival by informing post-LT patient management strategies.

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Risk Factors for End-Stage Kidney Disease After Pediatric Liver Transplantation

Cited by 31 publications

References 45 publications

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

Chronic Kidney Disease and Related Long-Term Complications After Liver Transplantation

Patient-Specific Prediction of ESRD after Liver Transplantation

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