Hemosiderosis: an unrecognized complication in renal allograft recipients

During the past decade, 258 patients received 293 renal transplants at Hennepin County Medical Center Minneapolis, Minnesota. Twenty-three of these patients had a pretransplant liver biopsy. Thirty-six patients had liver biopsies done during the post-transplant period. Liver tissue at autopsy was available from 24 patients who died after receiving a kidney transplant. Systematic analysis of the biopsy and autopsy specimens with appropriate tissue stains showed significant iron deposition (3+ to 4+) within the hepatic parenchymal cells in 1 of the 23 (4%) pretransplant biopsies and 17 of the 60 (28%) post-transplant specimens (P = 0.02). Eight of the 17 (47%) patients with post-transplant hemosiderosis also exhibited histological features of liver cirrhosis. As hemosiderosis is reversible with intermittent phlebotomies, early recognition and adequate management are highly desirable. We suggest that the serum ferritin level, which is a reliable index of body iron stores, should be monitored in all patients at periodic intervals following renal transplantation.