*Purpose: Progression to chronic renal disease (CKD) is highly prevalent in adults following liver transplantation (LT) with a profound impact on patient survival, assuming that the prevalence of renal dysfunction is also considerably high in children. We report our experiences in a large paediatric transplant center and try to identify risk factors leading to a decline of renal function.

*Methods: We retrospectively analyzed all 161 LT patients at our hospital from 2010 to 2017 (84 female). Medical records were reviewed for demographic, laboratory and clinical data. Patients were stratified into groups < 5 kg, 5-10 kg and > 10 kg. Change of renal function (slopes) was defined as loss/increase of GFR using the Schwartz formula and progress to renal failure within the first 4 weeks after LT was stratified according to the pRIFLE criteria. Mean observation time was 31 months (6 to 93 months).

*Results: Out of 161 patients, 134 were younger than 6 years at time of LT (74%). Average survival time in 5 years was 84%. CKD preexisted in 27 children (16.8%), twelve undergoing dialysis before LT (7.5%). 3/149 proceeded to ESRD over 5 years (2%). Other patients developed pRIFLE I (19,5%), II (17%), III (12%) within the first 4 weeks after LT. Average GFR within 4 weeks after LT was lower in group <5kg (66 ml/min/1.73m²) compared to 81 (5-10 kg) and 114 (>10kg) ml/min/1.73m². All GFR-slopes remained stable and were not significantly different from each other (<5kg: 0.01 vs. >5-10kg: 0,01 vs. >10kg: -0,35 ml/min/1,73m²/28 days). Within the entire observation time, all GFR-slopes showed a significant increase (<5kg: 14 vs. 5-10kg: 4 vs. >10kg: 3 ml/min/1.73m²/year). Regarding potential risk factors, 35 patients (22%) exceeded ABPM mean blood pressure values higher the 95th percentile, and 4 patients (2%) higher the 75th percentile. All other patients remained lower the 50th percentile. Proteinuria >30mg/dl did occur in 33% (n=53) of all patients and improved over years. Independent risk factors for a decline of GFR to ESRD were GFR decline within the first 28 days, days on ventilation, liver rejection, high MELD score, catecholamine and antihypertensive drug dosage, biliary leakage, proteinuria and high blood pressure.

*Conclusions: In contrast to adults, progress to ESRD in children following LT was rare (<5%) and most patients developed a normal GFR. Independent risk factors are rare and need further prospective analysis. However, renal function, hypertension and proteinuria should be monitored regularly.

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