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Renal Histopathological Lesions After Orthotopic Liver Transplantation (OLT)
Author(s) -
Pillebout Evangeline,
Nochy Dominique,
Hill Gary,
Conti Filomena,
Antoine Corinne,
Calmus Yvon,
Glotz Denis
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.00852.x
Subject(s) - medicine , transplantation , thrombotic microangiopathy , glomerulosclerosis , gastroenterology , nephrotoxicity , urology , nephropathy , renal function , dialysis , microangiopathy , liver transplantation , diabetes mellitus , pathology , kidney , proteinuria , endocrinology , disease
Liver transplant recipients are at risk of chronic renal failure (CRF), customarily considered to be secondary to CsA/FK506 nephrotoxicity. We have examined renal biopsies from 26 liver transplant recipients with CRF. Before OLT, 5 patients had CRF, 8 were diabetic and 9 hypertensive. Renal biopsies were performed at a mean of 5 years after liver transplantation. Mean SCr was then 212 μmol/L, proteinuria was 1 g/24 h. Twelve patients were diabetic and 25 hypertensive. Histology revealed impressive renal destruction, with a mean of 45% interstitial fibrosis and 45% glomerular sclerosis. All biopsies showed severe arteriosclerosis. CRF can be attributed to four associated primary lesions: (i) specific chronic CsA/FK506 arteriolopathy; (ii) typical diabetic nephropathy; (iii) acute or chronic thrombotic microangiopathy attributed to CsA/FK506 or α‐IFN and (iv) tubular changes related to administration of hydroxyethylstarch. At the end of the follow‐up, after a mean of 6.4 years, 12 patients required dialysis, 13 had CRF and only 1 had normal renal function. Thus, CRF in OLT recipients is more complex than originally thought and should not be classified as anti‐calcineurin nephrotoxicity without further investigations, including renal histology. These investigations have therapeutic potential, that is, they may lead to a more aggressive treatment of hypertension and/or diabetes.