Renal Recovery Following Orthotopic Liver Transplant after Prolonged Kidney Injury: Perspectives on Diagnosing Hepatorenal Syndrome and Determining Which Patients Should Undergo Simultaneous Liver–Kidney Transplantation
Main Article Content
Keywords
hepatorenal syndrome, liver cirrhosis, organ allocation, simultaneous liver–kidney transplantation, treatment outcome
Abstract
We present a case of an individual with cirrhosis and renal failure. This case is notable because the patient was found to have hepatorenal syndrome (HRS) superimposed on Immunoglobulin A (IgA) nephropathy. After 8 months of dialysis, the patient had significant renal recovery following orthotopic liver transplant (OLT). Cases such as this are not likely to be rare, as case series have shown that IgA deposits are a common occurrence in patients with cirrhosis, including those who have HRS. While current diagnostic criteria for HRS emphasize the importance of excluding glomerular lesions, we argue that this approach should be reconsidered. More specifically, we feel that the diagnostic approach to HRS should be more inclusive of cases in which patients have simultaneous HRS and glomerular injury. In addition, our case highlights the challenges in determining which patients will benefit most from simultaneous liver–kidney transplants over OLTs alone.
References
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13. Bloodworth JMB, Sommers SC. “Cirrhotic glomerulosclerosis,” a renal lesion associated with hepatic cirrhosis. Lab Invest. 1959;8:962–78.
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19. Nochy D, Callard P, Bellon B, Bariety J, Druet P. Association of overt glomerulonephritis and liver disease: A study of 34 patients. Clin Nephrol. 1976;6:422–7.
20. Nochy D, Druet P, Bariety JB. Other systemic diseases: IgA nephropathy in chronic liver disease. In: D’Amico G, Minetti L, Ponticelli C, editors. IgA mesangial nephropathy in contributions to nephrology. Milano: S. Karger; 1984. p. 268–75.
21. Patek AJ, Seegal D, Bevans M. The coexistence of cirrhosis of the liver and glomerulonephritis, report of 14 cases. Am J Med Sci. 1951;221:77–85. http://dx.doi.org/10.1097/00000441-195101000-00011
22. Sakaguchi H, Dachs S, Grishman E, Paronetto F, Salomon M, Churg J. Hepatic Glomerulosclerosis. Lab Investig. 1965;14:533–45.
23. Ting SMS, Toth T, Caskey F. a1-antitrypsin (A1AT) deficiency presenting with IgA nephropathy and nephrotic syndrome: Is renal involvement caused by A1AT deposition? Clin Nephrol. 2008;70:159–62. http://dx.doi.org/10.5414/CNP70159
24. Goetzmann L, Wagner-Huber R, Klaghofer R, Muellhaupt B, Clavien PA, Buddeberg C, et al. Waiting for a liver transplant: Psychosocial well-being, spirituality, and need for counselling. Transplant Proc. 2006;38:2931–6. http://dx.doi.org/10.1016/j.transproceed.2006.08.171
25. Pelgur H, Atak N, Kose K. Anxiety and depression levels of patients undergoing liver transplantation and their need for training. Transplant Proc. 2009;41(5):1743–8. http://dx.doi.org/10.1016/j.transproceed.2008.11.012
26. Santos GG, Goncalves LCS, Buzzo N, Mendes TAR, Dias TP, da Silva RCMA, et al. Quality of life, depression, and psychosocial characteristics of patients awaiting liver transplants. Transplant Proc. 2012;44:2413–15. http://dx.doi.org/10.1016/j.transproceed.2012.07.046
27. Chang Y, Gallon L, Jay C, Shetty K, Ho B, Levitsky J, et al. Comparative effectiveness of liver transplant strategies for end-stage liver disease patients on renal replacement therapy. Liver Transpl. 2014;20:1034–44. http://dx.doi.org/10.1002/lt.23899
28. Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: Where will MELD lead us? Am J Transplant. 2006;6(11):2651–9. http://dx.doi.org/10.1111/j.1600-6143.2006.01526.x
29. Locke JE, Warren DS, Singer AL, Segev DL, Simpkins CE, Maley WR, et al. Declining outcomes in simultaneous liver-kidney transplantation in the MELD era: Ineffective usage of renal allografts. Transplantation. 2008;85(7):935–42. http://dx.doi.org/10.1097/TP.0b013e318168476d
30. Aparici CM, Bains SN, Carlson D, Qian J, Liou D, Wojciechowski D, et al. Recovery of native renal function in patients with hepatorenal syndrome following combined liver and kidney transplant with mercaptoacetyltriglycine-3 renogram: Developing a methodology. World J Nucl Med. 2016;15(1):44–9.
31. Storm C, Bernhardt WM, Schaeffner E, Neuhaus R, Pascher A, Neuhaus P, et al. Immediate recovery of renal function after orthotopic liver transplantation in a patient with hepatorenal syndrome requiring hemodialysis for more than 8 months. Transplant Proc. 2007;39(2):544–6. https://dx.doi.org/10.1016/j.transproceed.2006.12.006
2. Johnson R, Couser W. Hepatitis B infection and renal disease: Clinical, immunopathogenic and therapeutic considerations. Kidney Int. 1990;37:663–75. http://dx.doi.org/10.1038/ki.1990.32
3. Gines P, Schrier RW. Renal failure in cirrhosis. NEJM. 2009;361:1279–90. http://dx.doi.org/10.1056/NEJMra0809139
4. Iwatsuki S, Popovtzer M, Corman J, Ishikawa M, Putnam C, Katz F, et al. Recovery from Hepatorenal syndrome after orthotopic liver transplantation. NEJM. 1973;289:1155–9. http://dx.doi.org/10.1056/NEJM197311292892201
5. Campbell M, Katlyar D, Bresinger C, Lewis J, Shetty K, Bloom R, et al. Renal function after orthotopic liver transplantation is predicted by duration of pretransplantation creatinine elevation. Liver Transplant. 2005;9:1048–55. http://dx.doi.org/10.1002/lt.20445
6. Liu Y. Renal fibrosis: New insights into the pathogenesis and therapeutics. Kidney Int. 2006;69:213–17. http://dx.doi.org/10.1038/sj.ki.5000054
7. Formica RN, Aeder M, Boyle G, Kucheryavaya A, Stewart D, Hirose R, et al. Simultaneous Liver-kidney allocation policy: A proposal to optimize appropriate utilization of scarce resources. Am J Transplant. 2016;16(3):758–66. http://dx.doi.org/10.1111/ajt.13631
8. Asch WS, Bia MJ. New organ allocation system for combined liver-kidney transplants and the availability of kidneys for transplant to patients with stage 4-5 CKD. Clin J Am Soc Nephrol. 2017;12(5):848–52. http://dx.doi.org/10.2215/CJN.08480816
9. Wadei HM, Gonwa TA, Taner CB. Simultaneous liver kidney transplant (SLK) allocation policy change proposal: Is it really a smart move? Am J Transplant. 2016;16(9):2763–4. http://dx.doi.org/10.1111/ajt.13844
10. Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet. 2003;362(9398):1819–27. http://dx.doi.org/10.1016/S0140-6736(03)14903-3
11. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J. Peripheral arterial vasodilation hypothesis: A proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology. 1988;8(5):1151–7. http://dx.doi.org/10.1002/hep.1840080532
12. Berger J, Yaneva H, Nabarra B. Glomerular changes in patients with cirrhosis of the liver. Adv Nephrol Necker Hosp. 1977;3:10–14.
13. Bloodworth JMB, Sommers SC. “Cirrhotic glomerulosclerosis,” a renal lesion associated with hepatic cirrhosis. Lab Invest. 1959;8:962–78.
14. Fisher ER, Hellstrom R. The membranous and proliferative glomerulonephritis of hepatic cirrhosis. Am J Clin Pathol. 1959;32:48–55. http://dx.doi.org/10.1093/ajcp/32.1.48
15. Horn RC, Smetana H. Intercapillary glomerulosclerosis. Am J Pathol. 1942;18:93–100.
16. Iida H, Izumino K, Matsumoto M, Takata M, Mizumura Y, Sugimoto T. Glomerular Deposition of IgA in experimental hepatic cirrhosis. Acta Pathol Jpn. 1985;35:561–67. http://dx.doi.org/10.1111/j.1440-1827.1985.tb00598.x
17. Nakamoto Y, Iida H, Kobayashi K, Dohi K, Kida H, Hattori N, et al. Hepatic glomerulonephritis, characteristics of hepatic IgA glomerulonephritis as the major part. Virchows Arch [Path Anat]. 1981;392:45–54. http://dx.doi.org/10.1007/BF00430547
18. Newell GC. Cirrhotic glomerulonephritis: Incidence, morphology, clinical features, and pathogenesis. Am J Kidney Dis. 1987;9:183–90. http://dx.doi.org/10.1016/S0272-6386(87)80053-7
19. Nochy D, Callard P, Bellon B, Bariety J, Druet P. Association of overt glomerulonephritis and liver disease: A study of 34 patients. Clin Nephrol. 1976;6:422–7.
20. Nochy D, Druet P, Bariety JB. Other systemic diseases: IgA nephropathy in chronic liver disease. In: D’Amico G, Minetti L, Ponticelli C, editors. IgA mesangial nephropathy in contributions to nephrology. Milano: S. Karger; 1984. p. 268–75.
21. Patek AJ, Seegal D, Bevans M. The coexistence of cirrhosis of the liver and glomerulonephritis, report of 14 cases. Am J Med Sci. 1951;221:77–85. http://dx.doi.org/10.1097/00000441-195101000-00011
22. Sakaguchi H, Dachs S, Grishman E, Paronetto F, Salomon M, Churg J. Hepatic Glomerulosclerosis. Lab Investig. 1965;14:533–45.
23. Ting SMS, Toth T, Caskey F. a1-antitrypsin (A1AT) deficiency presenting with IgA nephropathy and nephrotic syndrome: Is renal involvement caused by A1AT deposition? Clin Nephrol. 2008;70:159–62. http://dx.doi.org/10.5414/CNP70159
24. Goetzmann L, Wagner-Huber R, Klaghofer R, Muellhaupt B, Clavien PA, Buddeberg C, et al. Waiting for a liver transplant: Psychosocial well-being, spirituality, and need for counselling. Transplant Proc. 2006;38:2931–6. http://dx.doi.org/10.1016/j.transproceed.2006.08.171
25. Pelgur H, Atak N, Kose K. Anxiety and depression levels of patients undergoing liver transplantation and their need for training. Transplant Proc. 2009;41(5):1743–8. http://dx.doi.org/10.1016/j.transproceed.2008.11.012
26. Santos GG, Goncalves LCS, Buzzo N, Mendes TAR, Dias TP, da Silva RCMA, et al. Quality of life, depression, and psychosocial characteristics of patients awaiting liver transplants. Transplant Proc. 2012;44:2413–15. http://dx.doi.org/10.1016/j.transproceed.2012.07.046
27. Chang Y, Gallon L, Jay C, Shetty K, Ho B, Levitsky J, et al. Comparative effectiveness of liver transplant strategies for end-stage liver disease patients on renal replacement therapy. Liver Transpl. 2014;20:1034–44. http://dx.doi.org/10.1002/lt.23899
28. Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: Where will MELD lead us? Am J Transplant. 2006;6(11):2651–9. http://dx.doi.org/10.1111/j.1600-6143.2006.01526.x
29. Locke JE, Warren DS, Singer AL, Segev DL, Simpkins CE, Maley WR, et al. Declining outcomes in simultaneous liver-kidney transplantation in the MELD era: Ineffective usage of renal allografts. Transplantation. 2008;85(7):935–42. http://dx.doi.org/10.1097/TP.0b013e318168476d
30. Aparici CM, Bains SN, Carlson D, Qian J, Liou D, Wojciechowski D, et al. Recovery of native renal function in patients with hepatorenal syndrome following combined liver and kidney transplant with mercaptoacetyltriglycine-3 renogram: Developing a methodology. World J Nucl Med. 2016;15(1):44–9.
31. Storm C, Bernhardt WM, Schaeffner E, Neuhaus R, Pascher A, Neuhaus P, et al. Immediate recovery of renal function after orthotopic liver transplantation in a patient with hepatorenal syndrome requiring hemodialysis for more than 8 months. Transplant Proc. 2007;39(2):544–6. https://dx.doi.org/10.1016/j.transproceed.2006.12.006
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Jul 20, 2017
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How to Cite
Renal Recovery Following Orthotopic Liver Transplant after Prolonged Kidney Injury: Perspectives on Diagnosing Hepatorenal Syndrome and Determining Which Patients Should Undergo Simultaneous Liver–Kidney Transplantation. (2017). Journal of Renal and Hepatic Disorders, 1(2), 25-28. https://doi.org/10.15586/jrenhep.2017.20
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Case Reports Nephrology
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