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Sensorineural Hearing Loss in Children After Liver Transplantation
Ellen S. Deutsch, MD;
Victoria Bartling, MA;
Brian Lawenda, MD;
John Schwegler, MA;
Kathleen Falkenstein, MSN, CRNP;
Stephen Dunn, MD
Arch Otolaryngol Head Neck Surg. 1998;124:529-533.
Objective To investigate risk factors for sensorineural hearing loss (SNHL) in children after liver transplantation.
Design Retrospective medical record review.
Setting Pediatric tertiary care hospital.
Patients One hundred twenty-five consecutive children who received liver transplants between March 1, 1987, and June 30, 1996.
Main Outcome Measures The presence of SNHL (bone conduction threshold of >35 dB of hearing loss in at least 1 frequency) and the cause of the liver abnormality in all 125 patients. In addition, among the subset of children who had biliary atresia and underwent transplantation before 2 years of age, the total dose (milligrams per kilogram of body weight) of aminoglycoside antibiotic medications (tobramycin sulfate, gentamicin sulfate, and amikacin sulfate) and of intravenous loop diuretic agents (furosemide) was compared between children with and without SNHL.
Results Audiologic evaluations were available for 66 of 125 patients, 15 (12%) of whom have SNHL. Of 5 survivors with the short-bowel syndrome, 4 have severe to profound SNHL. Of 46 children who have biliary atresia and who underwent transplantation before 2 years of age, 8 (17%) have SNHL. Among the 26 evaluable children with biliary atresia undergoing liver transplantation before 2 years of age, logistic regression analysis revealed that the most important risk factor for SNHL was the cumulative dose of amikacin (P=.05).
Conclusions Children receiving liver transplants are at an increased risk for SNHL. Those with the short-bowel syndrome have the greatest prevalence of SNHL. Among the subset of children with biliary atresia receiving liver transplants before 2 years of age, statistical analysis demonstrates a dose-response relationship between the receipt of amikacin and the occurrence of SNHL.
From the Departments of Otorhinolaryngology and Bronchoesophagology (Drs Deutsch and Lawenda and Mr Schwegler) and Pediatric Surgery (Ms Falkenstein and Dr Dunn), Temple University School of Medicine and St Christopher's Hospital for Children, and the Department of Speech and Hearing, St Christopher's Hospital for Children (Ms Bartling), Philadelphia, Pa. Dr Deutsch is now with the Division of Pediatric Otolaryngology, Department of Surgery, duPont Hospital for Children, Wilmington, Del. Dr Lawenda is now with the San Diego Naval Medical Center, San Diego, Calif. Ms Falkenstein and Dr Dunn are now with the Allegheny Health, Education, and Research Foundation at St Christopher's Hospital for Children.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Neurologic complications of liver transplantation in adults
Lewis and Howdle
Neurology 2003;61:1174-1178.
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