Kidney histology and function in liver transplant patients.
BACKGROUND
Chronic kidney disease is a common complication after liver transplantation. However, few reports regarding kidney histology exist for this setting.


METHODS
Inulin clearance was measured and a kidney biopsy was performed in 99 patients at 60 ± 48 months after liver transplantation. Kidney biopsies were scored according to the Banff classification, and interstitial fibrosis was measured by a computerized quantitative method.


RESULTS
There was a steep decrease in kidney function within the first 6 months following transplantation, but this lessened thereafter. At kidney biopsy, inulin clearance and estimated glomerular filtration rate (eGFR) (using the abbreviated Modification of Diet in Renal Disease equation) were highly correlated (r(2) = 0.47, P < 0.0001). A decrease in eGFR at 6 months post-transplant was the sole predictive factor for inulin clearance of < 60 mL/min/1.73 m(2) at 5 years post-transplant. Few patients had a specific pattern of kidney histopathology and all patients had complex primary lesions. Lowered eGFR at 6 months post-transplant was a predictive factor for > 50% sclerotic glomeruli on the kidney biopsy. The duration of tacrolimus therapy, as compared to cyclosporine A, was a protective factor for < 20% interstitial fibrosis on the kidney biopsy.


CONCLUSIONS
In the setting of liver transplantation, this is the largest kidney-histology study to confirm that histological kidney lesions are complex, multiple and interrelated. Kidney function at 6 months post-transplant can predict long-term kidney function and histology.
Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France. kamar.n@chu-toulouse.fr
Nassim
N
Kamar
Céline
C
Guilbeau-Frugier
Aude
A
Servais
Ivan
I
Tack
Eric
E
Thervet
Olivier
O
Cointault
Laure
L
Esposito
Joelle
J
Guitard
Laurence
L
Lavayssière
Fabrice
F
Muscari
Christophe
C
Bureau
Lionel
L
Rostaing
D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007444:Inulin / Q000378:metabolism; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
D007444:Inulin