Clinical usefulness of kidney biopsy in liver transplant recipients with renal impairment

Abstract

BackgroundChronic kidney disease is a common complication after liver transplantation. In this study, we analyzed the results of kidney biopsy in liver transplantation recipients with renal impairment.MethodsBetween 1999 and 2012, 544 liver transplants were performed at our hospital. We retrospectively analyzed the clinical and histological data of 10 liver transplantation recipients referred for kidney biopsy.ResultsThe biopsies were performed at a median of 24.5 months (range, 3–73 months) after liver transplantation. The serum creatinine level was 1.81±0.5 mg/dL at the time of kidney biopsy. There were no immediate complications. The most common diagnosis was glomerulonephritis (GN), such as immunoglobulin A nephropathy (n=4), mesangial proliferative GN (n=1), focal proliferative GN (n=1), and membranous GN (n=1). Typical calcineurin inhibitor (CNI)-induced nephrotoxicity was detected in three cases (30%). Chronic tissue changes such as glomerulosclerosis, interstitial fibrosis, and tubular atrophy were present in 90%, 80%, and 80% of cases, respectively, and mesangial proliferation was detected in 40% of cases. We began treatment for renal impairment based on the result of kidney biopsy; for example, angiotensin-receptor blockers or steroids were prescribed for GN, and the CNI dose was reduced for CNI nephrotoxicity. As a result, eight of 10 patients showed improvement in glomerular filtration rate, but two progressed to end-stage renal disease.ConclusionKidney biopsy is a safe and effective method for determining the cause of renal impairment after liver transplantation. Management of patients based on the result of kidney biopsy may improve renal outcomes.

Renal histopathological lesions after liver transplantation: What can we find besides calcineurin inhibitor-induced nephrotoxicity?

“…Several data about renal biopsy after liver transplantation have been reported in recent years. Despite relatively small sample sizes (from 4 to 81 patients) and retrospective study designs, most of them have suggested that the etiology of CKD after liver transplantation is broad and complex and may only be assessed accurately by renal biopsy [4][5][6][7][8][9][10]. However, the importance of renal biopsy remains underestimated by clinicians, especially in mainland China.…”

“…The cumulative incidence of CKD after liver transplantation is 8.0%, 13.9%, and 18.1% over 1, 3, and 5 years, respectively [1]. Studies evaluating renal pathology after liver transplantation are sparse, and sample sizes are small [2][3][4][5][6][7][8][9][10]. Post-liver transplantation renal impairment is traditionally attributed to calcineurin inhibitors (CNI), a key component of immunosuppressive regimens for patients undergoing liver transplantation [1,3,11,12].…”

“…Post-liver transplantation renal impairment is traditionally attributed to calcineurin inhibitors (CNI), a key component of immunosuppressive regimens for patients undergoing liver transplantation [1,3,11,12]. However, several pieces of recent evidence have suggested that the cause of renal impairment may be complex [4][5][6][7][8][9][10]. Therefore, we performed the first renal histopathological exploration of liver transplant recipients who underwent renal biopsy in mainland China.…”

Hidden pathology of kidney disease after liver transplantation

“…In summary, recent studies including the cases described by Lee et al [9] suggest that we need to find causes other than CNI-induced nephrotoxicity in liver transplant recipients with kidney disease. Although some issues hamper the use of a kidney biopsy in routine clinical practice, kidney biopsies for selected patients are required to diagnose and manage the underlying kidney disease properly.…”

“…In the current issue of Kidney Research and Clinical Practice , Lee at al investigated histological findings of the kidney from 10 liver transplant recipients with decreased kidney function [9] . The most common diagnosis was glomerulonephritis (GN) such as immunoglobulin A nephropathy ( n =4), mesangial proliferative GN ( n =1), focal proliferative GN ( n =1), and membranous GN ( n =1).…”