title: Renal outcomes of liver transplant recipients who had pretransplant kidney biopsy.
abstract: BACKGROUND
  Kidney biopsy has been recommended to guide kidney allocation in selected liver transplant (LT) candidates with renal dysfunction. However, post-LT-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 (6-88) mL/min per 1.73 m(2) and 65 (0-4,338) 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.
authors.affiliation: 1 Department of Transplant, Mayo Clinic, Jacksonville, FL. 2 Section of Biostatistics, Mayo Clinic, Jacksonville, FL. 3 Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL. 4 Address correspondence to: Hani M. Wadei, M.D., Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224.
authors.forename: Hani M
authors.initials: HM
authors.lastname: Wadei
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
authors.forename: Martin L
authors.initials: ML
authors.lastname: Mai
authors.forename: Cherise
authors.initials: C
authors.lastname: Cortese
authors.forename: Barry G
authors.initials: BG
authors.lastname: Rosser
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gonwa
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D058625:End Stage Liver Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D005355:Fibrosis / Q000503:physiopathology; D005919:Glomerular Filtration Rate; D005923:Glomerulosclerosis, Focal Segmental / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D007684:Kidney Tubules / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D066027:Transplant Recipients; D016896:Treatment Outcome