Department of Nephrology, Dialysis, and Internal Disease, Medical University of Warsaw, Warsaw, Poland.
Ann Transplant. 2020 Oct 20;25:e925891. doi: 10.12659/AOT.925891.
Chronic kidney disease (CKD) has been recognized as an increasingly common complication of liver transplantation (OLTx). Post-transplant renal dysfunction contributes to long-term morbidity and mortality following OLTx and is a very important issue in the management of liver transplant recipients. Its etiology is multifactorial and can be determined by kidney biopsy, which is too rarely done in this patient group. In the clinical context of patients with liver cirrhosis, accurate and reliable evaluation of the renal injury is crucial. We performed a review of kidney biopsies in patients with symptoms of CKD (proteinuria/hematuria/elevated creatinine) before and after liver transplantation in the published literature. Kidney biopsies were performed either before or after liver transplantation using percutaneous technique. There are few reports on transjugular kidney biopsy. Biopsy results prevented unnecessary modification of immunosuppressive therapy or selection of candidates for liver transplantation. In our opinion, kidney biopsy is a clinically relevant diagnostic approach to recognize kidney disease before and after liver transplantation, it also helps with the management of kidney disease in this population, and it is safe. Kidney biopsy should be offered more often in liver transplant patients to ensure appropriate therapy in concomitant CKD in this population. Our decisions today will impact clinical outcomes in the future.
慢性肾脏病（CKD）已被认为是肝移植（OLTx）后越来越常见的并发症。移植后肾功能障碍导致 OLTx 后长期发病率和死亡率增加，是肝移植受者管理中的一个非常重要的问题。其病因是多因素的，可以通过肾活检来确定，但在该患者群体中，肾活检做得太少。在肝硬化患者的临床情况下，准确可靠地评估肾损伤至关重要。我们对发表的文献中肝移植前后有 CKD 症状（蛋白尿/血尿/肌酐升高）的患者的肾活检进行了回顾。使用经皮技术在肝移植前或肝移植后进行肾活检。关于经颈静脉肾活检的报道很少。活检结果可防止不必要地修改免疫抑制治疗或选择肝移植候选者。在我们看来，肾活检是一种临床相关的诊断方法，可在肝移植前后识别肾脏疾病，有助于管理该人群中的肾脏疾病，并且是安全的。应更频繁地为肝移植患者提供肾活检，以确保该人群中并存 CKD 的适当治疗。我们今天的决定将影响未来的临床结果。
