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Favorable Kidney Function in Pediatric Liver Transplant Recipients

Results of a Single-center Cohort Study

Sato, Mai MD1,2; Kaneko, Tetsuji3; Ogura, Masao MD1; Kamei, Koichi MD, PhD1; Ito, Shuichi MD, PhD2; Fukuda, Akinari MD, PhD4; Sakamoto, Seisuke MD, PhD4; Kasahara, Mureo MD, PhD4; Ishikura, Kenji MD, PhD1

doi: 10.1097/TP.0000000000002548
Original Clinical Science—Liver

Background. Although chronic kidney disease (CKD) is still a common complication, the prognosis of kidney function after liver transplantation (LT) is not well known. Moreover, kidney function after LT in children with renal involvement is unknown.

Methods. We retrospectively analyzed patients aged <20 years who underwent LT between November 2005 and March 2015 at our institute.

Results. The cohort included 313 pediatric LT recipients (135 males). The median age at LT was 1.1 years (interquartile range, 0.6 to 4.8 y), and the median duration of follow-up was 3.8 years (interquartile range, 1.7 to 6.2 y). We divided the patients by their primary disease into BA (biliary atresia), non-BA (other liver disease without primary renal involvement), or KD (patients with a pre-existing kidney disease) group, which comprised 141, 141, and 31 patients, respectively. Eight-year renal survival with stage 3 CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2) as the event was 99.2%, 92.4%, and 47.7% for the BA, non-BA, and KD group, respectively. Multivariate analysis disclosed primary kidney disease and multiple acute rejections as independent predictors of renal survival. The KD group showed no increase in the rate of kidney function deterioration after LT.

Conclusions. Eight-year renal survival with stage 3 CKD, particularly in patients with non–pre-existing KD, exceeded 92.0%, and end-stage kidney disease developed in only one patient. Kidney function can be highly preserved following LT even in patients with KD, provided that LT is not contraindicated in patients with renal involvement receiving optimal immunosuppressive management.

1 Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.

2 Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

3 Teikyo Academic Research Center, Teikyo University, Tokyo, Japan.

4 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.

Received 11 May 2018.

Accepted 3 November 2018.

K.I. has received research grants from Novartis Pharma, Chugai Pharma, and Astellas Pharma. K.I. also has received lecture fees from Novartis Pharma and Chugai Pharma. The other authors declare no conflicts of interest.

The authors declare no financial relationships relevant to this article.

M.S. prepared the article. M.O., K.K., A.F., and S.S. collected the clinical data. T.K. conducted statistical analysis. M.K. and S.I. revised the article. K.I. oversaw the work as the corresponding author and revised the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Kenji Ishikura, MD, PhD, Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan. (

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