20 October 2020: Review Paper
Clinical Relevance of Kidney Biopsy in Patients Qualified for Liver Transplantation and After This Procedure in the Model for End-stage Liver Disease (MELD) Era: Where Are We Today?
Monika Wieliczko ABCDEF , Urszula Ołdakowska-Jedynak BCEF , Jolanta Małyszko ABCDEFG*DOI: 10.12659/AOT.925891
Ann Transplant 2020; 25:e925891
Table 1 Kidney biopsy before liver transplantation.
| First author/reference number/study period | Number of patients | The most common causes of ESLD | Renal biopsy indication | Renal biopsy results | Clinical implication |
|---|---|---|---|---|---|
| Axelsen et al. [] 1989–199020 | 23 | PSC/PBC | Scr 80–180 μmol/LProteinuria | Minor glomerular abnormalities n=9IgA GN n=2Mesangiocapillary GN type I n=1Hepatic glomerulosclerosis n=8 | All biopsies showed glomerular abnormalities, which may contribute to the occurrence of post-transplant renal dysfunction. |
| McGuire et al. [] 200612 | 30 | HCV | NA | 25 patients had immune-complex glomerulonephritis:MPGN type 1 n=12IgAN n=7, and mesangial glomerulonephritis n=6 | Immune-complex glomerulonephritis was common in patients with end-stage HCV-induced cirrhosis and was often clinically silent.Its potential to cause renal failure after liver transplantation may be underappreciated.Of these patients, 10 had normal serum creatinine levels, normal urinalysis results, and normal quantitative proteinuria.For 5 others, the only renal abnormality was an increased serum creatinine level. |
| Wadei et al. [] 2005–200814 | 44 | HCV | GFR | IgAN n=20ATN n=13MPGN n=5DN n=5FSGS n=4)Advanced IF n=12Advanced gGS n=7Minimal changes n=11 | Renal biopsy is feasible in liver transplant candidates with moderate to severe renal failure and provides histological data that does not relate to the pretransplant clinical data.RB could be useful in selecting SLK candidates. |
| Calmus et al. [] 2003–200538 | 60 | ALDHCV+HBV | Unselected patient with ESLD undergoing screening for LTx | 25 pts had a morphological diagnosis of renal disease:IgA GN n=12DN n=10IgA GN+DN n=3Normal n=21 | In patients with ESLD, IgA nephropathy and diabetic lesions were frequently found despite the absence of renal impairment and/or urinalysis abnormalities.These results strongly suggest that severe renal failure develops preferentially in liver transplant recipients with DM or carbohydrate intolerance, and that pre-existing arterial lesions may favor the nephrotoxicity of CNIs. |
| Pichler et al. [] 2000–20186 | 59 | HCVALD | Liver transplant candidate with renal impairment of unclear etiology referred for SLK . LTx | MPGN 23% patientsFSGS 11%IgAN 19%ATN 19%Ischemic glomerulopathy 8.5%DN 8.5%Normal histology 8.5%TMA 4% | Renal biopsy can be relatively safe in this high-risk population, may help diagnose the etiology of renal disease, may predict post-transplant kidney function, and can be useful in kidney allocation for liver transplant candidates.The best histological predictor for post-transplant GFR in LTx group was the extent of global glomerulosclerosis. |
| Singh et al. [] 2005–201641 | 11 | HCVALDNALDPSCAlpha 1 deficiency | Liver transplant candidate with renal impairment of unclear etiology referred for SLK . LTX (eGFR ≤40 ml/min) | Minimal changes n=8DM n=2MPGN n=1 | LTx n=8SLKT n=3The level or duration of decreased e-GFR before LTx is insufficient to predict the irreversibility of post-transplant kidney function. |
| Wadei et al. [] 2002–201443 | 128 | HCVNALDCryptogenicPrimary biliary cirrhosis | Liver transplant candidate with renal impairment of unclear etiology referred for SLK . LTX (IGFR ≤40 ml/min or proteinuria >500 mg/d, or hematuria | Normal n=13ATN n=25MPGN n=19Minimal changes n=24Advanced interstitial fibrosis and GS n=47 | MELD score, serum creatinine, urinary sodium excretion, and renal size did not correlate with biopsy diagnosis; only SBP at the time of LTx evaluation correlates with renal histology. |
| AKI – acute kidney injury; ATN – acute tubular necrosis; CKD – chronic kidney disease; CNI – calcineurin inhibitor; CsA – cyclosporine A; DM – diabetes mellitus; DN – diabetic nephropathy; ESLD – end-stage liver disease; FSGS – focal segmental glomerulosclerosis; GN – glomerulonephritis; GS – glomerulosclerosis; HGS – hepatic glomerulosclerosis; HP – hypertension; iGFR – iothalamate glomerular filtration rate; IF – interstitial fibrosis; IgA – immunoglobulin A; HBV – hepatitis B virus; HCV – hepatitis C virus; ALD – alcoholic liver disease; IFTA – interstitial fibrosis and tubular atrophy; LAT – alone liver transplantation, LTx liver transplantation; MGA – minor glomerular abnormalities; MPGN – membranoproliferative glomerulonephritis; NA – not available; NALD – nonalcoholic liver disease; NASH – nonalcoholic steatohepatitis; NRSOT – nonrenal solid organ transplantation; PSC – primary sclerosing cholangitis; RB – renal biopsy; RRT – renal replacement therapy; SBP – systolic blood pressure; SLK – tx simultaneous-liver-kidney transplantation; TA – tubular atrophy; TAC – tacrolimus; TMA – thrombotic microangiopathy; TDV tenofovir associated nephrotoxicity. | |||||