Kidney allocation to liver transplant candidates with renal failure of undetermined etiology: Role of percutaneous renal biopsy

H. M. Wadei, X. J. Geiger, C. Cortese, Martin Mai, D. J. Kramer, B. G. Rosser, A. P. Keaveny, D. L. Willingham, N. Ahsan, T. A. Gonwa

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

The feasibility, value and risk of percutaneous renal biopsy (PRB) in liver transplant candidates with renal failure are unknown. PRB was performed on 44 liver transplant candidates with renal failure of undetermined etiology and glomerular filtration rate (GFR) <40 mL/min/1.73 m2 (n = 37) or on renal replacement therapy (RRT) (n = 7). Patients with ≥30% interstitial fibrosis (IF), ≥40% global glomerulosclerosis (gGS) and/or diffuse glomerulonephritis were approved for simultaneous-liver-kidney (SLK) transplantation. Prebiopsy GFR, urinary sodium indices, dependency on RRT and kidney size were comparable between 27 liver-transplant-alone (LTA) and 17 SLK candidates and did not relate to the biopsy diagnosis. The interobserver agreement for the degree of IF or gGS was moderate-to-excellent. After a mean of 78 ± 67 days, 16 and 8 patients received LTA and SLK transplants. All five LTA recipients on RRT recovered kidney function after transplantation and serum creatinine was comparable between LTA and SLK recipients at last follow-up. Biopsy complications developed in 13, of these, five required intervention. PRB is feasible in liver transplant candidates with renal failure and provides reproducible histological information that does not relate to the pretransplant clinical data. Randomized studies are needed to determine if PRB can direct kidney allocation in this challenging group of liver transplant candidates.

Original languageEnglish (US)
Pages (from-to)2618-2626
Number of pages9
JournalAmerican Journal of Transplantation
Volume8
Issue number12
DOIs
StatePublished - Dec 2008

Fingerprint

Renal Insufficiency
Transplants
Kidney
Biopsy
Liver
Renal Replacement Therapy
Glomerular Filtration Rate
Fibrosis
Glomerulonephritis
Liver Transplantation
Kidney Transplantation
Creatinine
Transplantation
Sodium
Serum

Keywords

  • Biopsy complications
  • Glomerulosclerosis
  • Hepatorenal syndrome
  • Kidney allocation
  • Kidney function
  • Liver transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Kidney allocation to liver transplant candidates with renal failure of undetermined etiology : Role of percutaneous renal biopsy. / Wadei, H. M.; Geiger, X. J.; Cortese, C.; Mai, Martin; Kramer, D. J.; Rosser, B. G.; Keaveny, A. P.; Willingham, D. L.; Ahsan, N.; Gonwa, T. A.

In: American Journal of Transplantation, Vol. 8, No. 12, 12.2008, p. 2618-2626.

Research output: Contribution to journalArticle

Wadei, HM, Geiger, XJ, Cortese, C, Mai, M, Kramer, DJ, Rosser, BG, Keaveny, AP, Willingham, DL, Ahsan, N & Gonwa, TA 2008, 'Kidney allocation to liver transplant candidates with renal failure of undetermined etiology: Role of percutaneous renal biopsy', American Journal of Transplantation, vol. 8, no. 12, pp. 2618-2626. https://doi.org/10.1111/j.1600-6143.2008.02426.x
Wadei, H. M. ; Geiger, X. J. ; Cortese, C. ; Mai, Martin ; Kramer, D. J. ; Rosser, B. G. ; Keaveny, A. P. ; Willingham, D. L. ; Ahsan, N. ; Gonwa, T. A. / Kidney allocation to liver transplant candidates with renal failure of undetermined etiology : Role of percutaneous renal biopsy. In: American Journal of Transplantation. 2008 ; Vol. 8, No. 12. pp. 2618-2626.
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