Biopsy- Diagnosed Renal Disease in Patients With Liver Transplantation.

Abstract

Objective: To perform a retrospective clinicopathological study of patients having renal biopsies before and/or after liver transplantation. Materials and Methods: The clinicopathological evaluation of all renal biopsies of patients with liver transplantation that had been archived to our department in the period between January 1990 and December 2012 was performed. Results:Nineteen percutaneous renal biopsies and also 18 graft liver biopsies of 10 liver transplant recipients were accessed among total 408 liver transplanted cases. The most frequent primary liver disease was HBV-related cirrhosis (n= 4) among all patients. Three of 10 patients had also renal transplantation before or at the same time of liver transplantation. Evidence of increased serum creatinine level was the most observed clinical findings at the time of renal biopsy. The mean interval of liver transplantation-to-renal biopsy was 1025 (range, 10-4980) days.The most common pathology in the renal biopsies was immune complex glomerulonephritis. One case with karyomegalic nephropathy was also recorded. In addition to glomerulonephritis, evidence of allergic tubulointerstitial nephritis (n=4) or chronic calcineurin inhibitor nephrotoxicity (n=2) was noted. Seven of 10 patients died at a mean time of 34 months (range, 1-70 months) after liver transplantation. Remaining three patients with a mean follow up of 128 months ( 67-193 months) were still alive with a functioning liver allograft but with chronic renal failure. Conclusion: The cooccurrence of chronic kidney disease before and after liver transplantation has a major impact on mortality. Thus, strategies need to be put in place for the early detection of these patients and preventive measures introduced to retard the progression of renal injuries.