1 years (range 0.6-18.7 years) that included both pre- and post-LT patients.[52] For children with acute renal injury, the pediatric modified RIFLE (Risk for renal selleck compound dysfunction, Injury to the kidney, Failure of the kidney, Loss of kidney function, and Endstage renal disease) criteria utilizes a combination of the eCCL by the Schwartz method and urine output to inform the severity of renal injury.[54] Renal insufficiency that would necessitate combined liver and kidney transplant (CLKT) is less common in children than adults.[55] Renal dysfunction among children with chronic liver disease can be quite variable. For example,
children with biliary atresia tend to have good renal function prior to and following liver transplant,[56, 57] while those with tyrosinemia may have a glomerular filtration rate of less than 55 mL/min/1.73 m2.[58] Significant renal disease can be associated with primary hyperoxaluria, congenital hepatic fibrosis, and methylmalonic acidemia. Renal dysfunction prior to LT can be exacerbated following LT, particularly in children with inborn errors IWR-1 research buy of metabolism, alpha-1-antitrypsin deficiency (A1ATD), and Alagille syndrome (AGS).[59-62] Increased susceptibility to renal toxicity caused by calcineurin inhibitors may be attributed to associated genetic polymorphisms
in the ABCB1 gene.[63] 16. Renal function should be assessed in all patients, with special emphasis on those with metabolic liver diseases associated with renal dysfunction (1-B) and those at increased risk for calcineurin inhibitor toxicity. (2-B) 17. Serum creatinine alone should not be used to assess renal function (1-B); either cystatin C (2-B) or the revised Schwartz Formula (2-C) should be used to estimate the glomerular filtration rate in children with chronic liver disease. check details 18. The modified Risk for Renal Dysfunction, Injury, Failure, Loss, and Endstage
renal disease could be used to assess the degree of acute renal injury. (2-B) Dental caries due to frequent and prolonged bottle-feeding occur in children with endstage liver disease.[64, 65] A survey of transplant centers in the United States noted that a dental infection prior to transplantation resulted in cancellation or postponement of LT (38% of responding sites) and post-LT sepsis from a suspected dental source (27% of sites).[66] Preventive oral health care strategies are important in this patient population.[66, 67] 19. Children with endstage liver disease should receive a careful oral examination looking for evidence of dental caries, gingival disease, or dental abscess; referral to a pediatric dentist should occur if abnormalities are identified. (2-B) General anesthesiology assessment should include determination of venous access, review of cardiovascular, respiratory, gastrointestinal, renal, central nervous system, hepatic, and hematological systems.