Renal biopsy in liver transplant recipients

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2009-07, Vol.24 (7), p.2276-2282
• Main Authors: O’Riordan, Aisling, Dutt, Neelanjana, Cairns, Hugh, Rela, Mohamed, O’Grady, John G., Heaton, Nigel, Hendry, Bruce M.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy; Emergency and intensive care: renal failure. Dialysis management; Female; histology; Humans; Intensive care medicine; Kidney - pathology; Kidney Diseases - etiology; Kidney Diseases - mortality; Kidney Diseases - pathology; liver; Liver Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Prospective Studies; renal; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; transplantation
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp112

Background. Renal impairment post-liver transplant (LT) is often attributed to calcineurin inhibitors (CNIs). A renal biopsy can be a useful tool but may be complicated in LT recipients. We aimed to determine the clinical scenarios that prompted a decision to perform a renal biopsy in this patient population, to assess histological findings and evaluate patient management and survival and renal outcome. Methods. Information on clinical variables and renal histology was extracted from single-centre prospectively compiled databases from 1996 onwards. Results. Over 2100 adults received an LT in the time period studied, and 54 of these (35 males and 19 females) were referred for renal review. Of these, 43% underwent a renal biopsy. They had a higher creatinine (P = 0.02), a greater deterioration in creatinine over the year prior to review and were more likely to be nephrotic (both P < 0.01). Histological findings included hypertensive changes (44%), CNI nephrotoxicity (48%), IgA nephropathy (9%), membranoproliferative glomerulonephritis (17%), acute tubular necrosis (4%), crescentic glomerulonephritis (4%) and diabetic nephropathy (9%). Major bleeding complications occurred in 17%. Treatment changed in the majority but, it was not significantly different in the two groups. Although initial renal function was worse in the biopsied group, final patient and renal survival did not differ between the two groups. Conclusion. 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.