Management of Renal Failure in the Liver Transplant Patient

Abstract

To examine several current issues in the management of patients undergoing orthotopic liver transplantation (OLT) with significant renal injury. Review of the recent literature suggests that the actual cause of acute kidney injury (AKI) in cirrhotic patients undergoing OLT may significantly influence outcomes. Strategies such a simultaneous liver-kidney transplant (SLK) and intraoperative renal replacement therapy have been employed to achieve comparable results to either single organ transplant or those without pre-OLT AKI. With the dramatic rise in acuity at the time of transplant, several strategies have been employed to influence outcomes in OLT recipients with concomitant renal failure. Furthermore, shifts in organ allocation policy have resulted in significant changes in the management of this patient population. At present, the impact of these evolving strategies on long-term graft and patient survival is unknown.