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Current aspects of renal dysfunction after liver transplantation
Mariana P Pacheco1, Luiz Augusto Carneiro-D'Albuquerque2, Daniel F Mazo1
1Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Sao Paulo, Brazil.
World Journal of Hepatology
|February 7, 2022
Summary
Chronic kidney disease (CKD) after liver transplantation (LT) impacts survival. Early nephroprotective strategies, like adjusting calcineurin inhibitor (CNI) use, are crucial for preserving kidney function in transplant recipients.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) significantly reduces survival rates in liver transplant (LT) recipients.
- The Model for End-Stage Liver Disease (MELD) score contributes to increased CKD incidence due to pre-existing renal impairment in patients undergoing LT.
- CKD post-LT is multifactorial, involving pre-transplant conditions, perioperative events, and nephrotoxic immunosuppressants.
Purpose of the Study:
- To critically assess the causes of renal dysfunction following liver transplantation.
- To review current methods for evaluating renal function in liver transplant recipients.
- To examine early and late interventions for preserving renal function post-LT.
Main Methods:
- Review of existing literature on renal dysfunction after liver transplantation.
- Analysis of methods for assessing glomerular filtration rate and detecting kidney injury.
- Evaluation of nephroprotective strategies, particularly concerning calcineurin inhibitors (CNI).
Main Results:
- Current methods for evaluating renal function in LT patients have limitations in early injury detection.
- Calcineurin inhibitors (CNI) are a major factor in post-LT nephrotoxicity.
- Early nephroprotective strategies are essential for mitigating renal damage.
Conclusions:
- Identifying at-risk patients and implementing preventive measures are critical for improving outcomes after LT.
- Nephroprotective strategies include optimizing CNI dosage, delaying CNI initiation, and using alternative immunosuppressants like mycophenolate mofetil and everolimus.
- Further research is needed to enhance early detection and management of kidney injury in liver transplant recipients.
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