Arterial Blood Pressure at Time of Liver Transplant (LT) Evaluation Correlates With Kidney Biopsy Findings in LT Candidates With Renal Dysfunction

H. Wadei, A. Peguero, A. Alsaad, M. Mai, K. Oshel, T. Gonwa, C. Taner, A. Keaveny.

Transplant, Mayo Clinic, Jacksonville, FL.

Meeting: 2015 American Transplant Congress

Abstract number: 55

Keywords: Allocation, Biopsy, Kidney/liver transplantation, Liver transplantation

Renal dysfunction is common in LT candidates; however, predicting post-LT renal recovery is sometimes difficult. Kidney biopsy is helpful in identifying reversible renal injury but is associated with significant risks.

Aim: identify non-invasive method to predict post-LT renal recovery.

Methods:129 LT candidates with renal dysfunction of unknown cause (defined as iothalamate GFR <40 ml/min) and/or proteinuria underwent percutaneous kidney biopsy at time of LT evaluation. Patients with ≥30% interstitial fibrosis (IF) and/or ≥30-40% glomerulosclerosis (GS) were listed for simultaneous liver-kidney transplantation (SLK) while patients with lesser degrees of IF/GS were listed for LT alone. Prior to kidney biopsy, 24-hr urine protein and sodium excretions along with systolic and diastolic blood pressures (SBP and DBP, respectively) were measured. The use of anti-hypertensive medications other than diuretics was recorded.

Results: 73 (57%) patients were listed for LT and 56 were listed for SLK. Table 1 lists the clinical and histological findings of the 2 groups.

Table 1: Clinical and pathological findings of 129 LT candidates with renal dysfunction

	Listed for LT n=73	Listed for SLK n=56	P
%GS	15±13	37±16	0.0001
%IF	9±5	25±14	0.0001
Age (yr)	59±7	60±8	0.3
% male	71	62	0.3
% Hepatitis C	41	44	0.4
% previous LT	17	29	0.3
% Diabetes mellitus	22	25	0.1
% on BP medications	9	27	0.01
Iothalamate GFR (ml/min)	30±17	26±11	0.1
% dialysis at biopsy	16	14	0.7
24-hr urine protein (mg/d)*	56 (0-5406)	135 (0-5604)	0.2
24-hr urine sodium (mEq/d)*	57 (0-289)	76 (0-238)	0.3
SBP (mmHg)	110±20	123±20	0.001
DBP (mmHg)	63±11	69±10	0.007

* Presented in median (range)Both SBP and DBP directly correlated with the degree of IF and GS (R=0.3, P<0.02 for all). SBP correlated with the final biopsy diagnosis and was lowest in patients with normal biopsies (P=0.001) (Figure1)Conclusions: In LT candidates with renal dysfunction: 1)arterial BP in the low-normal range correlated with histological evidence of reversible renal injury 2) Anti-hypertensive medication use was associated with a higher likelihood of irreversible renal damage.

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