Renal dysfunction in liver transplant recipients: Evaluation of the critical issues
- 8 October 2012
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 18 (11), 1290-1301
- https://doi.org/10.1002/lt.23522
Abstract
Major progress has been made in the field of liver transplantation since the first procedure was performed nearly 50 years ago. Despite these improvements, renal dysfunction before and after liver transplantation remains a major complicating factor associated with increased health care costs, morbidity, and mortality. Creatinine‐based estimates of renal function are inaccurate in the setting of end‐stage liver disease and often lead to underdiagnosis and late intervention. This issue is critical in that it is important to understand both the etiology and chronicity of renal dysfunction before liver transplantation because the treatment clearly varies, especially with respect to simultaneous liver‐kidney (SLK) transplantation. Because of the scarcity of available grafts, identifying appropriate candidates for SLK transplantation is crucial. Hepatorenal syndrome is common in liver transplant candidates; however, other etiologies of renal dysfunction need to be considered. Renal dysfunction after liver transplantation is common and may have an acute or chronic presentation. Although calcineurin inhibitors (CNIs) have been associated with post–liver transplant nephrotoxicity, their role may be overestimated, and other contributing etiologies should remain in a clinician's differential diagnosis. Alternatives to CNIs have been evaluated; however, a safe immunosuppressive regimen that achieves the preservation of renal function in liver transplant recipients remains to be established. In this review of the literature, renal dysfunction in the setting of liver transplantation is evaluated, and the critical issues that are barriers to improved outcomes are highlighted. Liver Transpl, 2012. © 2012 AASLD.Keywords
This publication has 54 references indexed in Scilit:
- A Decade of Experience Using mTor Inhibitors in Liver TransplantationJournal of Transplantation, 2011
- Risk factors for acute kidney injury following orthotopic liver transplantation: the impact of changes in renal function while patients await transplantationBMC Nephrology, 2010
- Evolution of Causes and Risk Factors for Mortality Post‐Liver Transplant: Results of the NIDDK Long‐Term Follow‐Up StudyAmerican Journal of Transplantation, 2010
- Remote Ischemic Preconditioning Reduces Myocardial Ischemia/Reperfusion InjuryJournal of Surgical Research, 2010
- Effect of pretransplant serum creatinine on the survival benefit of liver transplantationLiver Transplantation, 2009
- Hepatitis C infection and risk of diabetes: A systematic review and meta-analysisJournal of Hepatology, 2008
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- High prevalence of renal dysfunction in long-term survivors after pediatric liver transplantationThe Journal of Pediatrics, 2006
- Evaluation of serum cystatin C concentration as a marker of renal function in patients with cirrhosis of the liverGut, 2002
- A model to predict survival in patients with end-stage liver diseaseHepatology, 2001