Disease Spectrum And Significant Pathologic Findings In Renal Biopsies In Adult Patients Undergoing Liver Transplantation

Abstract

Objective: Acute kidney injury is common in patients undergoing liver transplantation post-operatively. Data regarding renal pathology during liver transplantation is limited in literature. This study aims at identifying renal disease spectrum and its relationship with renal function amongst these patients. Methods: This is a single-center prospective study. Patients undergoing liver transplantation from 2017 to 2019 were included with prior consent. An open trucut renal biopsy at upper pole of right kidney was performed after liver implantation. Those with hemodynamic instability at the time of induction of anesthesia were excluded. Clinical data were collected for data analysis. Results: 46 patients (34 male and 12 female) were enrolled in the study, with median age of 60 (25-69). Median follow up time was 13 months (1-24 months). 4 patients had pre-operative hepatorenal syndrome. Hepatitis B and/or C related cirrhosis was the commonest indication for transplantation (n=22), followed by HCC (n=11), alcoholic cirrhosis (n=7) and acute on chronic hepatitis B (n=5). 7 patients had inadequate material for diagnosis and were excluded in subsequent analysis. Acute tubular injury (ATI) was found in 23 of 46 patients. The presence of ATI had no association with subsequent renal function. Other pathologic findings included IgA nephropathy (n=9), mesangioproliferative glomerulonephritis (n=4), thin basement membrane disease (n=4) and bile cast nephropathy (n=3). 14 biopsies showed mild (n=13) or moderate (n=1) interstitial fibrosis and tubular atrophy (IFTA). The presence of IFTA was significantly associated with raised serum creatinine at 2, 3, 6 and 12-month interval post liver transplantation (p <0.05). Conclusions: A wide spectrum of renal diseases is present in renal biopsies for patients undergoing liver transplantation and ATI is the commonest diagnosis. The presence of IFTA during liver transplantation could be a potential predictor of subsequent renal function and a guide for the use of different immunosuppressive regimens.