PEDIATRICS

F. Brinkert¹, M.J. Kemper², A. Briem-richter³, R. Ganschow^3
1Department Of Pediatrics, Pediatric Gastroenterology And Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg/GERMANY, ²Pediatric Nephrology, Department Of Pediatrics, University Medical Center Hamburg, Hamburg/GERMANY, ³Department Of Hepatobiliary And Transplant Surgery, Pediatric Hepatology And Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg/GERMANY

Body: Introduction: Chronic kidney disease (CKD) has been increasingly shown to be a negative prognostic factor after Ltx. Creatinine based GFR formulas are notoriously insensitive. In children non-invasive testing by determination of serum cystatin c is feasible and repeatedly correlates to the gold-standards of GFR measurements. Aim of our study was to determine GFR using cystatin c (GFR_(cys)) in comparison to conventional calculated creatinine-clearance (GFR_(crea)) in the long-term follow-up after pLtx. Methods: GFR of 168 children following liver transplantation was determined using cystatin c (GFR_(cys)) and the Schwartz formula (GFR_(crea)). In order to evaluate risk factors for CKD a logistic regression analysis was performed. A multivariate model was applied to assess the impact of immunosuppressive treatment. Results: The mean follow-up after transplantation was 7.8 (0.44–15.72) years. Due to a high overestimation of GFR as demonstrated in a Bland-Altman-Plot only 3 patients with CKD stages 2-3 were detected with GFR_(crea) compared to 34 with GFR_(cys) (p<0.001). Thus, prevalence of CKD with GFR_(cys) < 90 ml/min/1.73m² was 30,4%, 7,6% and 27% in patients with 5, 10 and more than 10 years of follow-up, respectively. Patients on cyclosporine had a significantly lower GFR than patients on tacrolimus. Logistic regression analysis did not show any significant risk factor for the developing of CKD. Conclusions: Cystatin c equation is a non-invasive and sensitive diagnostic tool to detect renal dysfunction in children after Ltx at an early stage. The choice of the first line calcineurin inhibitor has an important impact on the development of CKD.

Disclosure: All authors have declared no conflicts of interest.