{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T17:52:58Z","timestamp":1766339578039,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic kidney disease (CKD) impacts long\u2010term morbidity in pediatric liver transplant (LT) recipients. The prevalence of estimated glomerular filtration rate (eGFR)\u00a0&lt;\u200990\u2009mL\/min\/1.73\u2009m<jats:sup>2<\/jats:sup> (eGFR\u2009&lt;\u200990) at our institution was 25% at 1\u2009year post\u2010LT; thus, quality improvement (QI) project was initiated, aiming to decrease the prevalence of eGFR\u2009&lt;\u200990 by at least 20% at 1\u2009year\u2010post LT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children post\u2010LT under 19\u2009years from 2010 to 2018 were included. Three QI interventions were implemented starting 1\/2016: documentation of blood pressure percentile (BP%) and eGFR, documentation of a kidney management plan if either was abnormal, and amlodipine initiation prior to hospital discharge after LT. We compared the prevalence of eGFR\u2009&lt;\u200990 at 3, 12, and 24\u00a0months after LT in the pre\u2010 and post\u2010intervention period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>68 patients in pre\u2010 and 42 in post\u2010intervention periods met inclusion criteria. Pre\u2010intervention BP%, eGFR, and kidney management plan were documented at 25%, 10%, and 22%, compared to 71%, 83%, and 71% post\u2010intervention, respectively. 22% of patients were started on amlodipine prior to discharge from LT in the pre\u2010 versus 74% in the post\u2010intervention period. Prevalence of eGFR\u2009&lt;\u200990 at 3\u00a0m post\u2010LT was 19% in pre\u2010 versus 14% in the post\u2010intervention period (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.31); at 12\u00a0months 24% versus 7% (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.01) and at 24\u00a0months 16% versus 6% (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.13), respectively. Significant non\u2010modifiable risk factors for eGFR\u2009&lt;\u200990 were malignancy (RR\u00a0=\u00a04.5, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001), metabolic disorder (RR\u00a0=\u00a02.6, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.02), and age at transplant (7% increased risk per year of age, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>By improving documentation of BP%, eGFR, and kidney management plan, the prevalence of eGFR\u2009&lt;\u200990 was decreased by a relative 74% and 60% at 12 and 24\u00a0months post\u2010LT, respectively.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14506","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T09:54:17Z","timestamp":1679306057000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A quality improvement intervention to decrease the decline in renal function in pediatric liver transplant recipients"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8767-331X","authenticated-orcid":false,"given":"Irini","family":"Batsis","sequence":"first","affiliation":[{"name":"Division of Hepatology Mount Sinai Kravis Children's Hospital  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2992-287X","authenticated-orcid":false,"given":"Scott","family":"Elisofon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Jonas","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2842-605X","authenticated-orcid":false,"given":"Brendan","family":"Kimball","sequence":"additional","affiliation":[{"name":"Department of Quality Improvement, Pediatric Transplant Center Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Institutional Centers for Clinical and Translational Research Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rima","family":"Fawaz","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition Yale New Haven Children's Hospital  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002592"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/11316180-000000000-00000"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03316.x"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14638"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.11.013"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cppeds.2018.08.006"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/14.2.384"},{"volume-title":"Pathophysiology and Treatment of Calcineurin Inhibitor Nephrotoxicity","year":"2014","author":"Kemper 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