J Pediatr 1986 Mar;108(3):393-8

Renal failure in children with hepatic failure undergoing liver transplantation

Ellis D, Avner ED, Starzl TE

Abstract
Over a 3 1/2 year period, 133 children with hepatic failure underwent orthotopic
liver transplantation (OLT) at our center. Renal failure (creatinine clearance
less than 20 ml/min/1.73 m2) was present in 19 (14.3%) of these children. In
seven of the 19 children, renal failure was present before OLT, and in the other
12 after OLT. The causes of renal failure included hepatorenal syndrome in
seven, postischemic acute tubular necrosis in five, severe prerenal azotemia in
five, and cyclosporine nephrotoxicity in two. Eight other patients died of renal
failure while awaiting emergency transplantation. Of the total of 31 deaths
among 133 children who underwent OLT, nine occurred in the 19 patients with
renal failure. Thus patients with OLT and renal failure had a significantly
higher mortality than other patients with transplants (P less than 0.025).
Dialysis was not associated with improved survival. The majority of deaths in
patients with renal failure were related to severe hemorrhage, thromboembolic
events, and systemic fungal infections. Our experience suggests that renal
failure is common in children with hepatic failure and is associated with
reduced patient survival after OLT