O'Riordan Aisling, Dutt Neelanjana, Cairns Hugh, Rela Mohamed, O'Grady John G, Heaton Nigel, Hendry Bruce M
Department of Renal Medicine, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Nephrol Dial Transplant. 2009 Jul;24(7):2276-82. doi: 10.1093/ndt/gfp112. Epub 2009 Mar 16.
Renal impairment post-liver transplant (LT) is often attributed to calcineurin inhibitors (CNIs). A renal biopsy can be a useful tool but may be complicated in LT recipients. We aimed to determine the clinical scenarios that prompted a decision to perform a renal biopsy in this patient population, to assess histological findings and evaluate patient management and survival and renal outcome.
Information on clinical variables and renal histology was extracted from single-centre prospectively compiled databases from 1996 onwards.
Over 2100 adults received an LT in the time period studied, and 54 of these (35 males and 19 females) were referred for renal review. Of these, 43% underwent a renal biopsy. They had a higher creatinine (P = 0.02), a greater deterioration in creatinine over the year prior to review and were more likely to be nephrotic (both P < 0.01). Histological findings included hypertensive changes (44%), CNI nephrotoxicity (48%), IgA nephropathy (9%), membranoproliferative glomerulonephritis (17%), acute tubular necrosis (4%), crescentic glomerulonephritis (4%) and diabetic nephropathy (9%). Major bleeding complications occurred in 17%. Treatment changed in the majority but, it was not significantly different in the two groups. Although initial renal function was worse in the biopsied group, final patient and renal survival did not differ between the two groups.
A renal biopsy is a valuable tool in those with renal insufficiency and/or proteinuria and haematuria but the benefits must be weighed against the relatively high complication rate in LT recipients.
肝移植（LT）后出现的肾功能损害通常归因于钙调神经磷酸酶抑制剂（CNIs）。肾活检可能是一种有用的工具，但在肝移植受者中可能会出现并发症。我们旨在确定促使对该患者群体进行肾活检的临床情况，评估组织学结果，并评估患者管理、生存情况以及肾脏结局。
从1996年起的单中心前瞻性汇编数据库中提取临床变量和肾脏组织学信息。
在研究期间，超过2100名成年人接受了肝移植，其中54人（35名男性和1名女性）被转诊进行肾脏检查。其中，43%接受了肾活检。他们的肌酐水平更高（P = 0.02），在检查前一年肌酐恶化程度更大，并且更有可能出现肾病（两者P < 0.01）。组织学结果包括高血压性改变（44%）、CNI肾毒性（48%）、IgA肾病（9%）、膜增生性肾小球肾炎（17%）、急性肾小管坏死（4%）、新月体性肾小球肾炎（4%）和糖尿病肾病（9%）。17%发生了严重出血并发症。大多数患者的治疗方案发生了改变，但两组之间没有显著差异。尽管活检组的初始肾功能较差，但两组的最终患者生存率和肾脏生存率并无差异。
肾活检对于肾功能不全和/或蛋白尿及血尿患者是一种有价值的工具，但必须权衡其益处与肝移植受者相对较高的并发症发生率。
