Key role of renal biopsy in management of progressive chronic kidney disease in liver graft recipients
Chronic kidney disease (CKD) is a common complication after liver transplantation (LT). The etiology of CKD is broad and may only be assessed accurately by renal histology. The current study aimed to analyze the safety of renal biopsy in daily clinical practice as well as its usefulness regarding management of CKD after LT.
We performed a retrospective analysis of clinical data and renal biopsies obtained from patients with severe renal impairment (overt proteinuria, progressive deterioration of renal function) after LT with respect to safety, etiology of renal disease, and therapeutic consequences.
Renal biopsies were obtained from 14 patients at median (minimum–maximum) 3 (0.2–12) years after LT. No major complications associated with renal biopsy were observed. Histomorphological alterations were varied (nephrosclerosis, n = 5; IgA-glomerulonephritis, n = 4; tenofovir-associated nephropathy, membranoproliferative glomerulonephritis type 1, membranous glomerulonephritis, amyloid A amyloidosis, and calcineurin inhibitor nephropathy, n = 1, respectively). The diagnosis of specific renal diseases other than calcineurin-inhibitor nephrotoxicity facilitated specific treaments and avoided unnecessary modification of immunosuppression in the majority of patients.
Renal biopsy in patients with CKD after LT seems safe and may offer specific therapeutic options. Furthermore, unnecessary changes of immunosuppression can be avoided in a considerable number of patients.
KeywordsChronic kidney disease Liver transplantation Biopsy Etiology
Chronic Kidney Disease Epidemiology Collaboration
Chronic kidney disease
Estimated glomerular filtration rate
Hepatitis B virus
Hepatitis C virus
Model of end stage liver disease
Mechanistic target of rapamycine
Upper limit of normal
Compliance with ethical standards
Conflict of interest
Martin-Walter Welker, Consultancies/speaker’s fees: AbbVie, Amgen, Bayer, BMS, Gilead, Novartis, Roche, Sequana Medical. Travel Support: AbbVie, Astellas, Bayer, BMS, Novartis, Janssen, Roche. Nina Weiler, Consultancies/speaker´s bureau for Astellas, Novartis. Wolf Otto Bechstein, Consultancies/speaker’s fees: Astellas, Celgene, Gilead, Integra, Medupdate, MerckSerono, Novartis, Teva. Eva Herrmann, nothing to report. Christoph Betz, noting to report. Mark Schöffauer, nothing to report. Stefan Zeuzem, Consultancies/speaker’s bureau for Abbvie, BMS, Gilead, Janssen, Merck. Christoph Sarrazin, Consultancies/Advisory boards: Abbott, BMS, Gilead, Janssen, Merck/MSD, Roche. Research support: Abbott, Gilead, Janssen, Siemens. Speaker: Abbott, BMS, Gilead, Janssen, Merck/MSD, Qiagen, Roche, Siemens. Kerstin Amann, Speaker/Advisory boards: Alexion, Böhringer Ingelheim. Oliver Jung, nothing to report. On behalf of the remaining authors, no financial, personal, or professional interests that could be construed to have influenced the paper have to be reported.
Study approval was obtained by the local Ethics Committee for Medical Research in accordance with the 1975 Declaration of Helsinki.
For this type of study formal consent is not required.
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