Renal biopsy in liver transplant recipients

O'Riordan, Aisling; Dutt, Neelanjana; Cairns, Hugh; Rela, Mohamed; O’Grady, John; Heaton, Nigel; Hendry, Bruce M.

doi:10.1093/ndt/gfp112

Cited by 42 publications

(52 citation statements)

References 43 publications

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“…6 Renal biopsy can be risky and is not routinely recommended in the coagulopathic liver disease patient. 20 Studies on this subject with clear diagnostic information on the causes of renal failure in this patient population are lacking. In designing this study, we minimized the chance of including patients with chronic renal disease by intentionally excluding those patients most likely to have chronic irreversible renal disease (ie, those undergoing CLKT).…”

Section: Discussionmentioning

confidence: 99%

Pretransplant predictors of recovery of renal function after liver transplantation

et al. 2010

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The Model for End-Stage Liver Disease system has given priority on the liver transplant waiting list to candidates with renal failure. This study determined the predictors of spontaneous recovery of renal function after transplantation in 1041 liver transplant recipients on renal replacement therapy (RRT) at the time of transplant (from February 2002 to January 2007). Data from these patients were obtained from the US Organ Procurement and Transplantation Network and US Renal Data System databases. Univariate and multivariate survival models were constructed along with multivariate logistic regression models to find independent predictors of spontaneous renal recovery. Seven hundred seven recipients (67.9%) had spontaneous recovery of renal function after liver transplantation. Those recovering spontaneously had a significantly shorter course of RRT in the pretransplant time period (15.6 versus 36.6 days, P < 0.001). Recovery of renal function was observed in 70.8% and 11.5% of recipients on RRT for less than 30 days and more than 90 days, respectively. Other statistically significant pretransplant variables independently associated with recovery of renal function included recipient age, recipient pretransplant diabetes, and donor age. In conclusion, the duration of pretransplant RRT is highly predictive of spontaneous renal recovery post-transplant. Liver transplant candidates requiring less than 30 days of pretransplant RRT are likely to spontaneously recover renal function after liver transplantation, whereas those on RRT for more than 90 days are not. In the era of Model for End-Stage Liver Disease (MELD)-based liver allocation, there has been a preference for organ allocation to those patients with renal dysfunction, with the result that more than 30% of patients awaiting liver transplantation have decreased renal function, including a substantial number that require renal replacement therapy (RRT). 1,2 This has coincided with a rise in combined liver-kidney transplantation (CLKT) in the past 7 years. Impaired renal function at the time of transplantation has been shown to have a detrimental impact on morbidity and mortality after liver transplantation. 2,3 Despite imprecise methods for measuring renal dysfunction, 4 it is clear that the pretransplant degree of renal insufficiency has a major impact on post-transplant survival. 5 Specifically, the length of pretransplant renal dysfunction predicts post-transplant renal insufficiency. Campbell et al. 6 demonstrated that the duration of pretransplant Abbreviations: CI, confidence interval; CLKT, combined liver-kidney transplantation; INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; N/A, not available; OR, odds ratio; RRT, renal replacement therapy; UNOS,

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Section: Discussionmentioning

confidence: 99%

Pretransplant predictors of recovery of renal function after liver transplantation

et al. 2010

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“…2,4,6,7,13,14 Major risk factors for chronic kidney disease after liver transplant include calcineurin inhibitors (cyclosporine and tacrolimus), diabetes mellitus, nephroangiosclerosis, previous use of hydroxyethyl starch, and the potential risk factors for chronic kidney disease after liver transplant include older age, non-Asian ethnicity, postoperative acute renal failure, and pretransplant obesity, hypertension, diabetes mellitus, low glomerular filtration rate, proteinuria, and renal replacement therapy. 7,13,14 Other possible causes of chronic kidney disease in liver transplant patients include hepatitis C virus-related kidney disease, IgA nephropathy caused by liver disease, and other glomerular diseases.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

“…[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. 1,2,5 Chronic kidney disease is a frequent complication of liver transplant, and the 5-year overall cumulative incidence of chronic kidney disease after liver transplant is 21% to 50%.…”

Section: Introductionmentioning

confidence: 99%

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2014

Exp Clin Transplant

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Objectives: The purpose of this study was to evaluate the causes of kidney impairment associated with liver transplant in patients who had kidney biopsy before or after liver transplant. Materials and Methods: In 408 patients who had liver transplant from January 1990 to December 2012, there were 10 patients who had kidney biopsy (total, 19 kidney biopsies) for evaluation of kidney dysfunction. A retrospective review of clinical records and kidney biopsies was performed. Results: There were 7 male and 3 female patients (median age at liver transplant, 43 y; range, 10 to 62 y). The most frequent reason for liver transplant were hepatitis B virus cirrhosis (4 patients). There were 3 patients who had a kidney transplant before or concurrent with liver transplant. Increased serum creatinine level was the most common clinical finding at the time of kidney biopsy. The median interval from liver transplant to kidney biopsy was 495 days (mean, 1025 d; range, 10-4980 d). The most common pathology in the kidney biopsies was immune complex glomerulonephritis (total, 7 patients: IgA nephropathy, 4 patients; lupus nephritis, 2 patients; membranoproliferative glomerulonephritis, 1 patient). There were 4 patients who had allergic tubulointerstitial nephritis, 2 patients who had chronic calcineurin inhibitor nephrotoxicity, and 1 patient who had karyomegalic nephropathy. There were 7 patients who died at mean 34 months (range, 1-70 mo) after liver transplant. The other 3 patients were alive at mean 128 months (range, 67-193 mo) after liver transplant and had a functioning liver graft and chronic kidney disease. Conclusions: Chronic kidney disease after liver transplant has a major effect on mortality. The frequency of immune complex glomerulonephritis associated with liver transplant may be greater than previously recognized.

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Renal dysfunction in liver transplant recipients: Evaluation of the critical issues

2012

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Major progress has been made in the field of liver transplantation since the first procedure was performed nearly 50 years ago. Despite these improvements, renal dysfunction before and after liver transplantation remains a major complicating factor associated with increased health care costs, morbidity, and mortality. Creatinine-based estimates of renal function are inaccurate in the setting of end-stage liver disease and often lead to underdiagnosis and late intervention. This issue is critical in that it is important to understand both the etiology and chronicity of renal dysfunction before liver transplantation because the treatment clearly varies, especially with respect to simultaneous liver-kidney (SLK) transplantation. Because of the scarcity of available grafts, identifying appropriate candidates for SLK transplantation is crucial. Hepatorenal syndrome is common in liver transplant candidates; however, other etiologies of renal dysfunction need to be considered. Renal dysfunction after liver transplantation is common and may have an acute or chronic presentation. Although calcineurin inhibitors (CNIs) have been associated with post-liver transplant nephrotoxicity, their role may be overestimated, and other contributing etiologies should remain in a clinician's differential diagnosis. Alternatives to CNIs have been evaluated; however, a safe immunosuppressive regimen that achieves the preservation of renal function in liver transplant recipients remains to be established. In this review of the literature, renal dysfunction in the setting of liver transplantation is evaluated, and the critical issues that are barriers to improved outcomes are highlighted. Liver Transpl 18:1290-1301, 2012. V C 2012 AASLD.Received January 11, 2012; accepted July 11, 2012.Since the first liver transplant in the early 1960s, great progress has been made in both the surgical and medical management of liver transplant recipients. Major strides have been made in overcoming obstacles such as acute and chronic rejection, and once dreaded infectious complications such as cytomegalovirus and hepatitis B infections are largely manageable. The associated surgical procedures have become almost routine at many centers because of advances in surgical techniques, organ preservation, and anesthetic management. What most significantly affects the long-term outcomes of liver transplant recipients are the medical complications of liver transplantation, which include recurrent hepatitis C, 1 diabetes mellitus, 2 malignancies, 3 and renal dysfunction. 4The development of renal dysfunction before or after liver transplantation remains a complicated, multifaceted, and critical issue that adversely affects a host of outcomes, which range from increased costs of care to inferior grafts and decreased patient survival. The

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Renal biopsy in liver transplant recipients

Abstract: A renal biopsy is a valuable tool in those with renal insufficiency and/or proteinuria and haematuria but the benefits must be weighed against the relatively high complication rate in LT recipients.

Cited by 42 publications

References 43 publications

Pretransplant predictors of recovery of renal function after liver transplantation

Pretransplant predictors of recovery of renal function after liver transplantation

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Renal dysfunction in liver transplant recipients: Evaluation of the critical issues

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