UNIVERSAL OCCURRENCE OF GLOMERULAR ABNORMALITIES IN PATIENTS RECEIVING LIVER-TRANSPLANTS

We conducted a prospective study of renal histology and function in 18 consecutive nonalcoholic patients underwent orthotopic liver transplantation (OLT). Despite well-preserved renal function, all patients had abnormal renal biopsies. Four patterns of glomerular injury were identified: minor glomerular abnormalities (eight patients), hepatic glomerulosclerosis (seven), membranoproliferative glomerulonephritis (one), and IgA nephropathy (one). In one patient there was insufficient tissue to allow classification. There was a trend toward lower plasma bilirubin and higher plasma albumin in patients with minor glomerular abnormalities than in the group of patients with more severe forms of glomerular injury (29 v 82 μmol/L, 35.5 v 30 g/L; P = 0.1, 0.1 > P > 0.05, respectively). Glomerular changes persisted in the three patients who died within 7 weeks post-OLT. IgM immunofluorescence was present in all biol and IgA in 11. IgM-containing circulating immune complexes occurred in five patients, suggesting a pathogenic for IgM immune complex deposition. The significance of cirrhosis-associated glomerular abnormalities is not yet known. They may contribute to the hepatorenal syndrome and the renal dysfunction that occurs in up to 94% of patients post-OLT. © 1992, National Kidney Foundation, Inc.. All rights reserved.