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NDT Advance Access originally published online on March 16, 2009
Nephrology Dialysis Transplantation 2009 24(7):2276-2282; doi:10.1093/ndt/gfp112
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Renal biopsy in liver transplant recipients

Aisling O’Riordan1, Neelanjana Dutt2, Hugh Cairns1, Mohamed Rela3, John G. O’Grady3, Nigel Heaton3 and Bruce M. Hendry1

1 Department of Renal Medicine 2 Department of Histopathology 3 Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK

Correspondence and offprint requests to: Aisling O’Riordan; E-mail: aisling.oriordan{at}kch.nhs.uk



  Abstract

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.

Keywords: biopsy; histology; liver; renal; transplantation

Received for publication: 4.11.08
Accepted in revised form: 24. 2.09


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