NEPHROTOXIC EFFECTS OF IMMUNOSUPPRESSANT THERAPY IN PAEDIATRIC LIVER TRANSPLANT RECIPIENTS.

Abstract

P704 Introduction: Drugs used for immunosuppression have been implicated in numerous long-term side-effects including nephrotoxicity and cholesterol problems. Method: Review of 24 of our paediatric liver recipients performed at Red Cross Children’s Hospital, in terms of glomerular filtration rate and lipid profiles. Results: To date a total of 78 paediatric liver transplants have been performed (32 who are being followed up locally) and 24 of these were reviewed at least 5 months to a maximum of 7.3 years post transplant. Combined liver and kidney transplants were performed in 3 patients. 9 Boys and 15 girls were assessed with a racial distribution of 19 mixed race, 3 black and 2 white patients. Mean age of patients at time of transplant was 6.6 years (0.8 - 13.3 years) with 8 cases under the age of 3 years. Mean time post transplant was 2.1 years. All were commenced on Cyclosporin A therapy but at the time of testing, immunosuppression included 6 children on Cyclosporin and 18 children on Tacrolimus. Radionuclide 51Cr-EDTA Glomerular Filtration Rate (GFR) studies showed a range of 21 to 220ml/minute/1.73m2 (mean = 96.1, median = 89.9ml/min/1.73m2). 7 cases had a GFR of less than 75ml/min/1.73m2.21 of the children were on antihypertensives: 15 on 1 agent and 6 on 2 agents.Full fasting lipid profiles were done and total cholesterol ranged from 2 to7.9 (mean= 4.4). Only 1 case is currently on statin therapy. Conclusion: Immunosuppressive therapies such as the calcineurin inhibitors are known to cause nephrotoxicity and this is of concern in paediatric liver transplant recipients. Almost all our patients in the group studied currently require antihypertensive therapy. At present, the renal function is stable in the majority of the group but this study needs to be extended to include our other paediatric liver transplant recipients, with particular emphasis on those who are now more than 5 years post transplant.