Introduction: The ever-growing number and increasing survival of liver transplantation (LT) allow better recognition of its associated renal injuries. Renal injury is a common problem after LT. Studies evaluating renal pathology Post-LT are sparse and sample sizes are small. Renal injury is traditionally attributed to calcineurin inhibitor (CNI) toxicity. This view was recently challenged. Many investigators have concluded that the cause of renal impairment may be multifactorial, and interconnected. Herein, we performed a clinicopathologic study of patients having renal biopsies after LT by reviewing 19 percutaneous renal biopsies from 10 patient in our institute.

Materials and Methods: A retrospective clinicopathologic study of all renal biopsies from patients with LT archived to the Department of Pathology, Başkent University Ankara Hospital during the period January 1990 to December 2012 was performed. Clinical data on presentation and follow up were retrieved from hospital records and physicians.

Results: In the 22-year period, 408 patients received LT in the Transplantation Surgery Center of Başkent University. Nineteen percutaneous renal biopsies were accessed from 10 liver transplant recipients (2 cadaveric donor, 8 living related donor ), in the Department of Pathology. The male to female ratio was 7:3 and the mean age at transplantation was 41 years (10-62 years). The mean interval of renal biopsy after LT was 20 months (range 2–166 months). Evidence of increased serum creatinine level (7 cases) and proteinuria (4 cases) were the most observed clinical presentations among our patients. The predominant glomerulopathy in these patients was membranoproliferative glomerulonephritis (MPGN) (n = 3). One patient had MPGN due to relapsing HCV hepatitis after LT. Two cases of IgA nephropathy, and one case of karyomegalic nephropathy were also recorded. In addition to glomerulonephritis, evidence of tubulointerstitial nephritis (TIN) was also found in four patients. One patient showed only TIN. Only two patients had findings of chronic CIT. Three of the patients also had renal transplantion befor or during LT. Seven of 10 patients died at mean 34 months (1–66 months) after LT. Of the remaining three patients with a mean follow up of 127 months (range, 67–193 months) were still alive with a functioning transplant liver.

Conclusions: The occurrence of chronic kidney disease before and after liver transplantation has a major impact on mortality. Additional studies are needed to understand better the natural history of chronic kidney disease among liver transplant recipients. Strategies need to be put in place for the early detection of these individuals and then preventive measures introduced to retard the progression of chronic kidney disease.