PEDIATRICS Vol. 67 No. 6 June 1981, pp. 855-861
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fennell, R. S.
Right arrow Articles by Richard, G. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fennell, R. S., III
Right arrow Articles by Richard, G. A.

Liver Dysfunction in Children and Adolescents During Hemodialysis and After Renal Transplantation

Robert S. Fennell III MD1, Joel M. Andres MD1, William W. Pfaff MD1, and George A. Richard MD1

1 Divisions of Pediatric Nephrology and Gastroenterology, Department of Pediatrics, and Division of Transplantation Surgery, Department of Surgery, University of Florida College of Medicine and Shands Teaching Hospital, Gainesville

Liver dysfunction is common in patients on hemodialysis or during the posttransplant period. Twelve children in the End-Stage Renal Disease Program at the University of Florida ranging in age from 4 to 18 years, developed persistent, elevated liver enzymes (SGOT or SGPT > 100 IU/liter) during hemodialysis in preparation for renal transplantation. Eleven of 12 developed enzyme elevations within six weeks of the initiation of hemodialysis. The other child exhibited enzyme elevations after one year on dialysis while awaiting a second transplant. Most of the children were anicteric and asymptomatic. Potential hepatotoxic drugs were discontinued when serum transaminase elevations were noted. Hepatitis B surface antigenemia was associated with enzyme elevations in one patient; cytomegalovirus seroconversion had occurred in eight patients, but only three had associated enzyme elevations. Liver biopsies were performed in all the patients before or at the time of renal transplantation. The histology was variable and ranged from normal in six patients, mildly abnormal with changes compatible with acute hepatitis in four patients, and granulomatous hepatitis in one patient, to severely abnormal with chronic hepatitis in the remaining patient. Seven of the 12 children underwent successful transplantation with return of enzyme levels to normal in five and persistent elevations in the others. These findings suggest that evaluation of liver histology provides the only accurate means of assessment of persistent liver dysfunction in children and adolescents on hemodialysis and after renal transplantation.

Submitted on November 7, 1979
Accepted on October 24, 1980