Journal of Nephrology

, Volume 32, Issue 1, pp 129–137 | Cite as

Key role of renal biopsy in management of progressive chronic kidney disease in liver graft recipients

  • Martin-Walter WelkerEmail author
  • Nina Weiler
  • Wolf Otto Bechstein
  • Eva Herrmann
  • Christoph Betz
  • Mark Schöffauer
  • Stefan Zeuzem
  • Christoph Sarrazin
  • Kerstin Amann
  • Oliver Jung
Original Article



Chronic kidney disease (CKD) is a common complication after liver transplantation (LT). The etiology of CKD is broad and may only be assessed accurately by renal histology. The current study aimed to analyze the safety of renal biopsy in daily clinical practice as well as its usefulness regarding management of CKD after LT.


We performed a retrospective analysis of clinical data and renal biopsies obtained from patients with severe renal impairment (overt proteinuria, progressive deterioration of renal function) after LT with respect to safety, etiology of renal disease, and therapeutic consequences.


Renal biopsies were obtained from 14 patients at median (minimum–maximum) 3 (0.2–12) years after LT. No major complications associated with renal biopsy were observed. Histomorphological alterations were varied (nephrosclerosis, n = 5; IgA-glomerulonephritis, n = 4; tenofovir-associated nephropathy, membranoproliferative glomerulonephritis type 1, membranous glomerulonephritis, amyloid A amyloidosis, and calcineurin inhibitor nephropathy, n = 1, respectively). The diagnosis of specific renal diseases other than calcineurin-inhibitor nephrotoxicity facilitated specific treaments and avoided unnecessary modification of immunosuppression in the majority of patients.


Renal biopsy in patients with CKD after LT seems safe and may offer specific therapeutic options. Furthermore, unnecessary changes of immunosuppression can be avoided in a considerable number of patients.


Chronic kidney disease Liver transplantation Biopsy Etiology 



Alanine transaminase


Aspartate transaminase


Chronic Kidney Disease Epidemiology Collaboration


Chronic kidney disease




Calcineurin inhibitor(s)


Cyclosporine A


Diabetic nephropathy


Estimated glomerular filtration rate


Hepatitis B virus


Hepatocellular carcinoma


Hepatitis C virus




Model of end stage liver disease




Mycophenolate mofetil


Mechanistic target of rapamycine


Liver transplantation




Standard deviation






Upper limit of normal


Compliance with ethical standards

Conflict of interest

Martin-Walter Welker, Consultancies/speaker’s fees: AbbVie, Amgen, Bayer, BMS, Gilead, Novartis, Roche, Sequana Medical. Travel Support: AbbVie, Astellas, Bayer, BMS, Novartis, Janssen, Roche. Nina Weiler, Consultancies/speaker´s bureau for Astellas, Novartis. Wolf Otto Bechstein, Consultancies/speaker’s fees: Astellas, Celgene, Gilead, Integra, Medupdate, MerckSerono, Novartis, Teva. Eva Herrmann, nothing to report. Christoph Betz, noting to report. Mark Schöffauer, nothing to report. Stefan Zeuzem, Consultancies/speaker’s bureau for Abbvie, BMS, Gilead, Janssen, Merck. Christoph Sarrazin, Consultancies/Advisory boards: Abbott, BMS, Gilead, Janssen, Merck/MSD, Roche. Research support: Abbott, Gilead, Janssen, Siemens. Speaker: Abbott, BMS, Gilead, Janssen, Merck/MSD, Qiagen, Roche, Siemens. Kerstin Amann, Speaker/Advisory boards: Alexion, Böhringer Ingelheim. Oliver Jung, nothing to report. On behalf of the remaining authors, no financial, personal, or professional interests that could be construed to have influenced the paper have to be reported.

Ethical statement

Study approval was obtained by the local Ethics Committee for Medical Research in accordance with the 1975 Declaration of Helsinki.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  • Martin-Walter Welker
    • 1
    Email author
  • Nina Weiler
    • 1
  • Wolf Otto Bechstein
    • 2
  • Eva Herrmann
    • 3
  • Christoph Betz
    • 4
  • Mark Schöffauer
    • 1
    • 4
  • Stefan Zeuzem
    • 1
  • Christoph Sarrazin
    • 1
    • 5
  • Kerstin Amann
    • 6
  • Oliver Jung
    • 4
    • 7
  1. 1.Medizinische Klinik IUniversitätsklinikum FrankfurtFrankfurt am MainGermany
  2. 2.Klinik für Allgemein- und ViszeralchirurgieUniversitätsklinikum FrankfurtFrankfurt am MainGermany
  3. 3.Institut für Biostatistik und mathematische ModellierungUniversitätsklinikum FrankfurtFrankfurt am MainGermany
  4. 4.Medizinische Klinik IIIUniversitätsklinikum FrankfurtFrankfurt am MainGermany
  5. 5.St. Josefs-HospitalWiesbadenGermany
  6. 6.Abteilung für NephropathologieUniversitätsklinikum ErlangenErlangenGermany
  7. 7.KfH Kuratorium für Dialyse und Nierentransplantation e.V., Standort Klinikum Frankfurt HöchstFrankfurt am MainGermany

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