Renal histopathological lesions after orthotopic liver transplantation (OLT).
Liver transplant recipients are at risk of chronic renal failure (CRF), customarily considered to be secondary to CsA/FK506 nephrotoxicity. We have examined renal biopsies from 26 liver transplant recipients with CRF. Before OLT, 5 patients had CRF, 8 were diabetic and 9 hypertensive. Renal biopsies were performed at a mean of 5 years after liver transplantation. Mean SCr was then 212 micromol/L, proteinuria was 1 g/24 h. Twelve patients were diabetic and 25 hypertensive. Histology revealed impressive renal destruction, with a mean of 45% interstitial fibrosis and 45% glomerular sclerosis. All biopsies showed severe arteriosclerosis. CRF can be attributed to four associated primary lesions: (i) specific chronic CsA/FK506 arteriolopathy; (ii) typical diabetic nephropathy; (iii) acute or chronic thrombotic microangiopathy attributed to CsA/FK506 or alpha-IFN and (iv) tubular changes related to administration of hydroxyethylstarch. At the end of the follow-up, after a mean of 6.4 years, 12 patients required dialysis, 13 had CRF and only 1 had normal renal function. Thus, CRF in OLT recipients is more complex than originally thought and should not be classified as anti-calcineurin nephrotoxicity without further investigations, including renal histology. These investigations have therapeutic potential, that is, they may lead to a more aggressive treatment of hypertension and/or diabetes.
Pillebout
Evangeline
E
Hopital Saint Louis, Nephrology and Kidney Transplantation, Paris, France. evangeline.pillebout@sls.ap-hop-paris.fr
Nochy
Dominique
D
Hill
Gary
G
Conti
Filomena
F
Antoine
Corinne
C
Calmus
Yvon
Y
Glotz
Denis
D
D000328:Adult; D000368:Aged; D001706:Biopsy; D003920:Diabetes Mellitus / Q000473:pathology; D005260:Female; D005922:Glomerulonephritis, IGA / Q000473:pathology; D006085:Graft Survival; D006505:Hepatitis / Q000628:therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D016898:Interferon-alpha / Q000378:metabolism; D007668:Kidney / Q000187:drug effects / Q000293:injuries* / Q000473:pathology; D007674:Kidney Diseases / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D016030:Kidney Transplantation; D008099:Liver; D008108:Liver Diseases, Alcoholic / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000209:etiology*; D012306:Risk; D016559:Tacrolimus / Q000494:pharmacology; D013997:Time Factors
D006895:Hydroxyethyl Starch Derivatives; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D016559:Tacrolimus