Data concerning the utility of kidney biopsy in liver transplant (LT) candidates with renal dysfunction and/or proteinuria is lacking. Methods: 67 LT candidates with iothalamate GFR<40 ml/min and/or proteinuria underwent pre-LT percutaneous kidney biopsy. Candidates with interstitial fibrosis (IF) or glomerulosclerosis (GS) ≥30% received simultaneous liver-kidney transplantation (SLK, n=25), while the remaining patients received LT alone (LTA) (n=42). Primary endpoint was the incidence of ESRD at last post-tx follow-up (FU). Results: Indications for kidney biopsy were GFR<40 ml/min (n=17), dialysis (n=9), proteinuria and GFR <40 (n=39) and proteinuria alone (n=2). Biopsy related bleeding occurred in 8 patients (12%). Table presents characteristics and kidney biopsy findings of LTA and SLK recipients.
|LTA (n=42)||SLK (n=25)||P|
|% Male gender||71||80||0.4|
|% Dialysis at biopsy||14||16||0.9|
|Pre-LT GFR (ml/min)||28±14||24±8||0.3|
|24-hr urine protein (mg/d)||69 (0-4338)||286 (0-7020)||0.2|
|Kidney size (cm)||11±2||11±1||0.7|
|MELD score at LT||23±6||24±6||0.4|
|Crt at last FU* (mg/dl)||1.5±0.6||1.2±0.4||0.02|
The incidence of ESRD at last FU was comparable between LTA and SLK recipients (figure).
ESRD following LTA was associated with surgical re-exploration (HR=10, CI=1.7-54, P=0.008), bacteremia (HR=9, CI=1.1-78, P=0.02) and CMV disease (HR=8.0, CI=1.5-45, P=0.01) but did not relate to dialysis at LT (P=0.2), pre-LT dialysis duration (P=0.6) or pre-LT GFR (P=0.9).
Conclusions: 1) Incidence of post-LT ESRD is comparable between LTA and SLK recipients who had pre-LT kidney biopsy for renal dysfunction and/or proteinuria. 2) Post-LT events rather than pre-LT factors determine the risk of post-LT ESRD. 3) Crt at last FU is higher but acceptable in LTA compared to SLK recipients.
To cite this abstract in AMA style:Wadei H, Mai M, Prendergast M, Keaveny A, Pungpapong S, Gonwa T. Comparable Risk of End-Stage Renal Disease (ESRD) in Liver Transplant Alone (LTA) and Simultaneous Liver Kidney (SLK) Recipients Who Had Pre-LT Kidney Biopsy for Renal Dysfunction or Proteinuria [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/comparable-risk-of-end-stage-renal-disease-esrd-in-liver-transplant-alone-lta-and-simultaneous-liver-kidney-slk-recipients-who-had-pre-lt-kidney-biopsy-for-renal-dysfunction-or-proteinuria/. Accessed December 1, 2023.
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