Biopsy‐Diagnosed Renal Disease in Patients After Transplantation of Other Organs and Tissues

Abstract

Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolyticuremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI.

Renal pathology in hematopoietic cell transplant recipients: a contemporary biopsy, nephrectomy, and autopsy series

“…8,11,14,16,18,39,45 We encountered focal segmental glomerulosclerosis in 3 of 14 (21%, patient nos. 6-8) patients with renal biopsy.…”

“…8,18,[26][27][28][29][30][31][32][33][34][35][36][37] In studies also examining nonglomerular pathology, kidney specimens also show concomitant tubulointerstitial and vascular changes in hematopoietic cell transplant patients. 8,14,16,19,38,39 A few single-center studies of autopsy kidney specimen in the hematopoietic cell transplant population have been reported, including one large study focused primarily on thrombotic microangiopathy. 20,21,38,40 We retrospectively reviewed our single-center experience with renal pathology in specimens from three groups of hematopoietic cell transplant recipients.…”

Post-bone marrow transplant thrombotic microangiopathy

“…59 Despite some improvements in overall outcomes, renal dysfunction after BMT remains a significant complication, and regardless of the cause, up to 8% of BMT patients require renal replacement therapy. 84,85 Schwarz et al 86 reported the results of 105 renal biopsies from 101 non-renal transplant recipients including liver, lung, bone marrow and heart. Patients with transplant-associated TMA, regardless of transplant type, had the shortest kidney survival.…”

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“…Studies about kidney pathology before and after liver transplant are few and sample sizes are small. [1][2][3][4][5] Chronic kidney disease affects 30% to 50% nonrenal organ transplant recipients and causes increased morbidity and mortality in these patients. [6][7][8] Chronic kidney disease also may occur before liver transplant, possibly because of hepatitis C virus-related kidney disease, cirrhotic glomerulonephritis, immunoglobulin A (IgA) nephropathy caused by liver disease, hypertensionrelated nephropathy, diabetic nephropathy, and other glomerular diseases.…”

“…[6][7][8] Chronic kidney disease also may occur before liver transplant, possibly because of hepatitis C virus-related kidney disease, cirrhotic glomerulonephritis, immunoglobulin A (IgA) nephropathy caused by liver disease, hypertensionrelated nephropathy, diabetic nephropathy, and other glomerular diseases. [1][2][3][4][5][6][7][8][9][10][11] Kidney injury commonly is attributed to chronic calcineurin inhibitor nephrotoxicity, especially after liver transplant. 3,4,6 However, other studies suggest that kidney impairment may be caused by several interconnected factors.…”