Kidney Week

Abstract: TH-PO1270

Biopsy-Guided Management Improves Renal Outcomes After Liver Transplantation: A Matched Cohort Study

Session Information

• Late-Breaking Research Posters
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Liu, Xiaoyan, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Xiaoyan Liu, MD, PhD

• Cai, Anxiang, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Anxiang Cai, PhD

• Jin, Haijiao, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Haijiao Jin, PhD

• Bian, Yize, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Yize Bian

• Wang, Qin, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Qin Wang

• Qian, Yongbing, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Yongbing Qian, MD

• Zhang, Jiang, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Jiang Zhang, MD

• Xu, Yao, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Yao Xu

• Zhou, Wenyan, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Wenyan Zhou, MD

• Qi, Chaojun, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Chaojun Qi, PhD

• Zhang, Minfang, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Minfang Zhang, MD

• Zhang, Jianjun, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Jianjun Zhang, MD

• Mou, Shan, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Shan Mou

Background

Chronic kidney disease (CKD) is a major complication of liver transplantation, conventionally attributed to calcineurin inhibitor (CNI) nephrotoxicity, and managed empirically without histological confirmation. Recent studies have suggested diagnostic heterogeneity in these patients; however, whether histology-guided management improves clinical outcomes remains unclear. Therefore, we aimed to compare kidney function outcomes between biopsy-guided and empirically managed liver transplant recipients with CKD.

Methods

This retrospective matched-cohort study included liver transplant recipients with new-onset CKD. Among the 359 eligible patients, 35 (9.7%) underwent kidney biopsy, and 324 (90.3%) received empirical management. The biopsy and non-biopsy groups were matched in a 1:1 ratio based on baseline serum creatinine levels. Biopsy findings were reviewed at multidisciplinary conferences to formulate pathology-directed treatment strategies.

Results

Kidney biopsy revealed marked pathological heterogeneity, with 70.4% patients demonstrating multiple overlapping pathologies. The most common findings were chronic tubulointerstitial lesions, arteriolosclerosis, and microangiopathy. At 12 months, the biopsy group demonstrated decreased serum creatinine (117.8 ± 25.7 vs. 154.8 ± 64.2 μmol/L, P = 0.022) and increased estimated glomerular filtration rate (58.4 ± 13.3 vs. 46.7 ± 17.4 mL/min/1.73m2, P = 0.022). The biopsy group had higher rates of nephrotoxic antineoplastic agents adjustment (29.6% vs. 3.7%, P = 0.015) and angiotensin converting enzyme inhibitor or angiotensin II receptor blocker initiation (51.9% vs. 0%, P < 0.001).

Conclusion

Diagnostic kidney biopsy with pathology-guided multidisciplinary management improved renal outcomes. These findings challenge the empirical CNI-focused treatment paradigm and support integrating kidney biopsy into standard care pathways for post-transplant CKD.