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Kidney Failure and Liver Allocation: Current Practices and Potential Improvements.

Varun Saxena¹, Jennifer C Lai¹

¹Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA.

Advances in Chronic Kidney Disease

|August 28, 2015

Summary

This summary is machine-generated.

The Model for End-Stage Liver Disease (MELD) score, used in liver transplant prioritization, has increased kidney dysfunction in patients. This review examines current practices and potential improvements for liver transplantation in patients with kidney dysfunction.

Keywords:

Acute kidney injury Biomarkers Creatinine Liver transplant Model for end-stage liver disease

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Area of Science:

Nephrology
Hepatology
Transplantation Medicine

Background:

The Model for End-Stage Liver Disease (MELD) score, implemented in 2002 for liver transplant prioritization, uses serum creatinine to assess kidney function.
This has led to a rise in documented kidney dysfunction and failure among end-stage liver disease patients awaiting or undergoing transplantation.

Purpose of the Study:

To review current practices for liver transplantation in patients with kidney dysfunction.
To identify pitfalls in existing protocols.
To discuss potential improvements in managing kidney function during liver transplantation.

Main Methods:

Literature review of current practices and challenges in liver transplantation for patients with kidney dysfunction.
Discussion of simultaneous liver-kidney transplantation decisions.
Analysis of potential advancements in kidney function assessment and management.

Main Results:

The MELD score's reliance on creatinine has highlighted the increasing prevalence of kidney dysfunction in liver transplant candidates.
Current practices face challenges in adequately managing kidney dysfunction.
Simultaneous liver-kidney transplantation is a key consideration.

Conclusions:

Improvements are needed in managing kidney dysfunction in liver transplant recipients.
Potential enhancements include utilizing the MELD-Na score, exploring alternatives to creatinine-based kidney function estimates, and employing intraoperative kidney replacement therapy.