Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy

Hani M. Wadei, Michael G. Heckman, Bhupendra Rawal, C. Burcin Taner, Martin Mai, Cherise Cortese, Barry G. Rosser, Thomas A. Gonwa, Andrew P. Keaveny

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background. Kidney biopsy has been recommended to guide kidney allocation in selected liver transplant (LT) candidates with renal dysfunction. However, postYLT-alone renal outcomes in recipients who showed evidence of reversible renal injury and limited chronicity on pre-LT kidney biopsy are unclear. Methods. Renal outcomes of 41 LT recipients who had pre-LT kidney biopsy for unexplained renal dysfunction, proteinuria, and hematuria were retrospectively reviewed. All biopsies showed less than 30% interstitial fibrosis and less than 30% to 40% glomerulosclerosis. Study endpoints were renal replacement therapy (RRT) at 1 month and the need for kidney transplantation at 1 year from LT. Results. Six patients were on RRT at time of biopsy. Median (range) iothalamate glomerular filtration rate and 24-hr urinary protein excretion for the remaining 35 patients were 29 (6Y88) mL/min per 1.73 m2 and 65 (0Y4,338) mg/day, respectively. Glomerulonephritis and acute tubular necrosis were present in 28 (68%) and 16 (39%) of the cases. Six patients (15%) did not recover kidney function at 1 month and RRT at time of LT was the only factor associated with this endpoint (P=0.04). Seven of the 31 (22%) patients with 1-year data met criteria for kidney transplantation within the first post-LT year. Surgical re-exploration was the only factor associated with the need for kidney transplantation at 1 year (P=0.05). Conclusions. The most LT recipients with minimal chronic changes on pre-LT kidney biopsy recovered kidney function within 1 month from LT. A small but significant percentage met criteria for kidney transplantation at 1 year because of the development of unforeseen post-LT complications.

Original languageEnglish (US)
Pages (from-to)1323-1330
Number of pages8
JournalTransplantation
Volume98
Issue number12
DOIs
StatePublished - 2014

Fingerprint

Kidney
Biopsy
Liver
Transplants
Kidney Transplantation
Renal Replacement Therapy
Transplant Recipients
Iothalamic Acid
Hematuria
Glomerulonephritis
Glomerular Filtration Rate
Proteinuria
Fibrosis
Necrosis
Wounds and Injuries
Proteins

Keywords

  • Hepatorenal syndrome
  • Kidneyliver transplantation
  • PreYliver transplant proteinuria
  • PreYliver transplant renal dysfunction

ASJC Scopus subject areas

  • Transplantation

Cite this

Wadei, H. M., Heckman, M. G., Rawal, B., Taner, C. B., Mai, M., Cortese, C., ... Keaveny, A. P. (2014). Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy. Transplantation, 98(12), 1323-1330. https://doi.org/10.1097/TP.0000000000000215

Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy. / Wadei, Hani M.; Heckman, Michael G.; Rawal, Bhupendra; Taner, C. Burcin; Mai, Martin; Cortese, Cherise; Rosser, Barry G.; Gonwa, Thomas A.; Keaveny, Andrew P.

In: Transplantation, Vol. 98, No. 12, 2014, p. 1323-1330.

Research output: Contribution to journalArticle

Wadei, HM, Heckman, MG, Rawal, B, Taner, CB, Mai, M, Cortese, C, Rosser, BG, Gonwa, TA & Keaveny, AP 2014, 'Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy', Transplantation, vol. 98, no. 12, pp. 1323-1330. https://doi.org/10.1097/TP.0000000000000215
Wadei, Hani M. ; Heckman, Michael G. ; Rawal, Bhupendra ; Taner, C. Burcin ; Mai, Martin ; Cortese, Cherise ; Rosser, Barry G. ; Gonwa, Thomas A. ; Keaveny, Andrew P. / Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy. In: Transplantation. 2014 ; Vol. 98, No. 12. pp. 1323-1330.
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abstract = "Background. Kidney biopsy has been recommended to guide kidney allocation in selected liver transplant (LT) candidates with renal dysfunction. However, postYLT-alone renal outcomes in recipients who showed evidence of reversible renal injury and limited chronicity on pre-LT kidney biopsy are unclear. Methods. Renal outcomes of 41 LT recipients who had pre-LT kidney biopsy for unexplained renal dysfunction, proteinuria, and hematuria were retrospectively reviewed. All biopsies showed less than 30{\%} interstitial fibrosis and less than 30{\%} to 40{\%} glomerulosclerosis. Study endpoints were renal replacement therapy (RRT) at 1 month and the need for kidney transplantation at 1 year from LT. Results. Six patients were on RRT at time of biopsy. Median (range) iothalamate glomerular filtration rate and 24-hr urinary protein excretion for the remaining 35 patients were 29 (6Y88) mL/min per 1.73 m2 and 65 (0Y4,338) mg/day, respectively. Glomerulonephritis and acute tubular necrosis were present in 28 (68{\%}) and 16 (39{\%}) of the cases. Six patients (15{\%}) did not recover kidney function at 1 month and RRT at time of LT was the only factor associated with this endpoint (P=0.04). Seven of the 31 (22{\%}) patients with 1-year data met criteria for kidney transplantation within the first post-LT year. Surgical re-exploration was the only factor associated with the need for kidney transplantation at 1 year (P=0.05). Conclusions. The most LT recipients with minimal chronic changes on pre-LT kidney biopsy recovered kidney function within 1 month from LT. A small but significant percentage met criteria for kidney transplantation at 1 year because of the development of unforeseen post-LT complications.",
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T1 - Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy

AU - Wadei, Hani M.

AU - Heckman, Michael G.

AU - Rawal, Bhupendra

AU - Taner, C. Burcin

AU - Mai, Martin

AU - Cortese, Cherise

AU - Rosser, Barry G.

AU - Gonwa, Thomas A.

AU - Keaveny, Andrew P.

PY - 2014

Y1 - 2014

N2 - Background. Kidney biopsy has been recommended to guide kidney allocation in selected liver transplant (LT) candidates with renal dysfunction. However, postYLT-alone renal outcomes in recipients who showed evidence of reversible renal injury and limited chronicity on pre-LT kidney biopsy are unclear. Methods. Renal outcomes of 41 LT recipients who had pre-LT kidney biopsy for unexplained renal dysfunction, proteinuria, and hematuria were retrospectively reviewed. All biopsies showed less than 30% interstitial fibrosis and less than 30% to 40% glomerulosclerosis. Study endpoints were renal replacement therapy (RRT) at 1 month and the need for kidney transplantation at 1 year from LT. Results. Six patients were on RRT at time of biopsy. Median (range) iothalamate glomerular filtration rate and 24-hr urinary protein excretion for the remaining 35 patients were 29 (6Y88) mL/min per 1.73 m2 and 65 (0Y4,338) mg/day, respectively. Glomerulonephritis and acute tubular necrosis were present in 28 (68%) and 16 (39%) of the cases. Six patients (15%) did not recover kidney function at 1 month and RRT at time of LT was the only factor associated with this endpoint (P=0.04). Seven of the 31 (22%) patients with 1-year data met criteria for kidney transplantation within the first post-LT year. Surgical re-exploration was the only factor associated with the need for kidney transplantation at 1 year (P=0.05). Conclusions. The most LT recipients with minimal chronic changes on pre-LT kidney biopsy recovered kidney function within 1 month from LT. A small but significant percentage met criteria for kidney transplantation at 1 year because of the development of unforeseen post-LT complications.

AB - Background. Kidney biopsy has been recommended to guide kidney allocation in selected liver transplant (LT) candidates with renal dysfunction. However, postYLT-alone renal outcomes in recipients who showed evidence of reversible renal injury and limited chronicity on pre-LT kidney biopsy are unclear. Methods. Renal outcomes of 41 LT recipients who had pre-LT kidney biopsy for unexplained renal dysfunction, proteinuria, and hematuria were retrospectively reviewed. All biopsies showed less than 30% interstitial fibrosis and less than 30% to 40% glomerulosclerosis. Study endpoints were renal replacement therapy (RRT) at 1 month and the need for kidney transplantation at 1 year from LT. Results. Six patients were on RRT at time of biopsy. Median (range) iothalamate glomerular filtration rate and 24-hr urinary protein excretion for the remaining 35 patients were 29 (6Y88) mL/min per 1.73 m2 and 65 (0Y4,338) mg/day, respectively. Glomerulonephritis and acute tubular necrosis were present in 28 (68%) and 16 (39%) of the cases. Six patients (15%) did not recover kidney function at 1 month and RRT at time of LT was the only factor associated with this endpoint (P=0.04). Seven of the 31 (22%) patients with 1-year data met criteria for kidney transplantation within the first post-LT year. Surgical re-exploration was the only factor associated with the need for kidney transplantation at 1 year (P=0.05). Conclusions. The most LT recipients with minimal chronic changes on pre-LT kidney biopsy recovered kidney function within 1 month from LT. A small but significant percentage met criteria for kidney transplantation at 1 year because of the development of unforeseen post-LT complications.

KW - Hepatorenal syndrome

KW - Kidneyliver transplantation

KW - PreYliver transplant proteinuria

KW - PreYliver transplant renal dysfunction

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