Background: Renal biopsy has been proposed to determine the cause or reversibility of renal failure for patients with ESLD and may be useful in the kidney allocation. Nevertheless, little data exists to validate the usefulness of kidney biopsies in this patient population. Methods: We evaluated the utility of renal biopsies in a cohort of 59 consecutive liver transplant candidates with renal impairment of unclear etiology referred to determine the need for kidney with liver transplant (SLK) versus liver alone transplantation (LAT). Pathological diagnoses, patient outcomes and the usefulness of biopsy results in predicting renal recovery were analyzed. Results: Our biopsy complication rate was relatively low with only 2.9% and 4.2% serious complications occurring with transjugular and percutaneous renal biopsies, respectively. The most common pathological diagnoses on renal biopsies were membranoproliferative glomerulonephritis (23%) followed by IgA-Nephropathy (19%) and acute tubular injury (19%). SLK was recommended for patients with >40% global glomerular sclerosis, or with interstitial fibrosis of > 30% or for patients on hemodialysis for >= 2 months. The best histological predictor for posttransplant GFR in the LAT group was the extent of global glomerulosclerosis (p=0.0001). Based on biopsy criteria we were able to avoid kidney allocation to 70% of our patients with renal dysfunction. Over the first year posttransplant, SLK and LAT patients had comparable eGFRs. Kaplan Meier survival analysis did not demonstrate a difference in patient survival between patients who underwent LAT versus SLK. Conclusion: Renal biopsy can be relatively safe in this population, may help elucidate the etiology of renal failure, may predict post LAT kidney function and may be helpful in kidney allocation for liver transplant candidates. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
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