The Variable Pathology of Kidney Disease After Liver Transplantation

Kim, Jin Yon; Akalin, Enver; Dikman, Steven; Gagliardi, Rosemarie; Schiano, Thomas D.; Bromberg, Jonathan S.; Murphy, Barbara; Boccardo, Graciela de

doi:10.1097/tp.0b013e3181c353e5

Cited by 67 publications

(71 citation statements)

References 25 publications

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“…1,2,4,5 The most common type of glomerulonephritis was IgA nephropathy (40%) ( Table 2), consistent with a previous report. 1 Although IgA nephropathy is the most common type of primary chronic glomerulonephritis worldwide, the pathogenesis of this nephropathy is controversial.…”

Section: Discussionsupporting

confidence: 81%

“…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%

“…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%. 7,12,13 However, kidney biopsy is not frequently performed in patients after liver transplant.…”

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%

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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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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Untitled

2014

Exp Clin Transplant

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Spatial distribution of kidney disease in the contaminated site of Taranto (Italy)

Benedetti

Santis

Manno

et al. 2017

American J Industrial Med

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Discovery and Validation of a Biomarker Model (PRESERVE) Predictive of Renal Outcomes After Liver Transplantation

Levitsky¹,

Asrani

Klintmalm

et al. 2020

Hepatology

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BaCKgRoUND aND aIMS:A high proportion of patients develop chronic kidney disease (CKD) after liver transplantation (LT). We aimed to develop clinical/protein models to predict future glomerular filtration rate (GFR) deterioration in this population. appRoaCH aND ReSUltS: In independent multicenter discovery (CTOT14) and single-center validation (BUMC) cohorts, we analyzed kidney injury proteins in serum/plasma samples at month 3 after LT in recipients with preserved GFR who demonstrated subsequent GFR deterioration versus preservation by year 1 and year 5 in the BUMC cohort. In CTOT14, we also examined correlations between serial protein levels and GFR over the first year. A month 3 predictive model was constructed from clinical and protein level variables using the CTOT14 cohort (n = 60). Levels of β-2 microglobulin and CD40 antigen and presence of hepatitis C virus (HCV) infection predicted early (year 1) GFR deterioration (area under the curve [AUC], 0.814). We observed excellent validation of this model (AUC, 0.801) in the BUMC cohort (n = 50) who had both early and late (year 5) GFR deterioration. At an optimal threshold, the model had the following performance characteristics in CTOT14 and BUMC, respectively: accuracy (0.75, 0.8), sensitivity (0.71, 0.67), specificity (0.78, 0.88), positive predictive value (0.74, 0.75), and negative predictive value (0.76, 0.82). In the serial CTOT14 analysis, several proteins, including β-2 microglobulin and CD40, correlated with GFR changes over the first year. CoNClUSIoNS:We have validated a clinical/protein model (PRESERVE) that early after LT can predict future renal deterioration versus preservation with high accuracy. This model may help select recipients at higher risk for subsequent CKD for early, proactive renal sparing strategies. (Hepatology

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The Variable Pathology of Kidney Disease After Liver Transplantation

Cited by 67 publications

References 25 publications

Untitled

Untitled

Spatial distribution of kidney disease in the contaminated site of Taranto (Italy)

Discovery and Validation of a Biomarker Model (PRESERVE) Predictive of Renal Outcomes After Liver Transplantation

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