Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Clin Transplant. 2012 Jan-Feb;26(1):E48-54. doi: 10.1111/j.1399-0012.2011.01542.x. Epub 2011 Oct 23.
Chronic kidney disease in liver transplant (OLT) recipients is often attributed to calcineurin inhibitors (CNI) toxicity, but little is known about the spectrum of their renal histological lesions.
Between 1988 and 2008, 1698 OLTs were performed in our center. We retrospectively analyzed clinical and histological data on 23 recipients (1.4%) referred for kidney biopsy (KB).
Median age at OLT was 50.2 yr, 65.2% were men, 30.4% had hepatitis C, and 95.7% were given CNI. KB was performed 6.9 yr (median) post-OLT. Median creatinine was 1 mg/dL pre-OLT and 2.2 mg/dL at KB. Main pathological diagnoses were focal segmental and global glomerulosclerosis (n = 8, 34.8%), glomerular diseases (7, 30.4%), CNI toxicity (2, 8.7%), and diabetic nephropathy (2, 8.7%). Moderate/severe interstitial fibrosis, tubular atrophy, arteriosclerosis, and hyalinosis were present in 47.8%, 43.5%, 60.9%, and 56.5%, respectively. Twelve patients (52.5%) reached end-stage renal disease (ESRD) and 17 (73.9%) died. Death was more common among those reaching ESRD, but the difference was not significant (83.3% vs. 63.6%, p = 0.37).
Renal histology is variable and not limited to CNI toxicity in OLT recipients referred for KB. Whether management based on KB findings can directly improve outcomes remains unclear.
肝移植（OLT）受者的慢性肾病通常归因于钙调神经磷酸酶抑制剂（CNI）毒性，但对其肾脏组织学病变的范围知之甚少。
在 1988 年至 2008 年期间，我们中心进行了 1698 例 OLT。我们回顾性分析了 23 例（1.4%）因肾活检（KB）转介的患者的临床和组织学数据。
OLT 时的中位年龄为 50.2 岁，65.2%为男性，30.4%患有丙型肝炎，95.7%接受了 CNI。KB 是在 OLT 后 6.9 年进行的。OLT 前肌酐中位数为 1mg/dL，KB 时为 2.2mg/dL。主要的病理诊断为局灶节段性和全球性肾小球硬化（n=8，34.8%）、肾小球疾病（7，30.4%）、CNI 毒性（2，8.7%）和糖尿病肾病（2，8.7%）。47.8%、43.5%、60.9%和 56.5%分别存在中度/重度间质纤维化、肾小管萎缩、动脉硬化和玻璃样变性。12 例患者（52.5%）进入终末期肾病（ESRD），17 例（73.9%）死亡。进入 ESRD 的患者死亡率更高，但差异无统计学意义（83.3%比 63.6%，p=0.37）。
OLT 受者因 KB 而转介的肾脏组织学表现多样，不仅限于 CNI 毒性。基于 KB 结果的管理是否能直接改善结局尚不清楚。
