Vlist, C. van der (Cato) (2019) Early CNI withdrawal after liver transplantation at paediatric age is associated with conservation of long-term renal function. thesis, Medicine.
Full text available on request.Abstract
English summary Introduction: After liver transplantation at paediatric age (pLT) patients receive lifelong immunosuppressive treatment, usually including calcineurin inhibitors (CNI). CNI are known to have nephrotoxic side effects. However, little is known about long-term renal effects after pLT. This study aimed to determine the risk of developing chronic kidney insufficiency (CKI) and identify risk factors for CKI in patients at least 15 years after pLT. Methods: All pLT patients from the University Medical Centre Groningen with a follow-up of at least 15 years were included. Renal function expressed in eGFR was calculated using the bedside Schwartz formula and CKD-EPI formula for children and adults, respectively. The definition of CKI was an eGFR <60 mL/min/1.73 m2 for two consecutive annual visits, or the need for renal replacement therapy. Cox regression analyses were performed for CKI. Results: In total, 13 (12%) out of 113 included patients developed CKI, of whom 3 developed end-stage renal disease and required kidney transplantation. Median follow-up after pLT was 22 years (range 15-35 years). Overall, there was a significant mean decrease in pre-pLT eGFR compared to eGFR at last follow-up (p=0.01). CNI withdrawal within 2 years after pLT was strongly associated with long-term conservation of kidney function (p=0.03), whereas concomitant renal disease seemed to be a risk factor for developing CKI. Conclusion: Our unique cohort of patients with a minimum of 15 years follow-up shows that 12% of the patients developed CKI during follow up, mostly occurring 20 years after pLT. Our early CNI withdrawal regimen was associated with a significantly lower risk of developing CKI. Our data compellingly show that a CNI withdrawal regimen relatively early after pLT is associated with conservation of renal function at adult age.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Direct supervisor: and Besouw, Dr. M.T.P and Faculty supervisor: and Verkade, Prof. Dr. H.J. and Location: and Paediatric Nephrology and Paediatric Gastroenterology UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/478 |
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