Renal dysfunction and the liver transplant recipient; novel strategies for determination of reversibility and renal protective therapies pretransplant and posttransplant

Abstract

Renal dysfunction is one of the most common and important complications in liver transplant candidates and recipients. Recent publications have highlighted important developments in this field. Inclusion of the serum creatinine in the Model for Endstage Liver Disease (MELD) score has led to an increased number of liver transplant candidates and recipients with renal dysfunction. The development of posttransplant renal dysfunction negatively impacts patient survival. Therefore, the careful identification of appropriate candidates for simultaneous liver-kidney (SLK) transplant is critical. Recent publications have helped in the appropriate selection of SLK recipients. One of the most important strategies to help mitigate renal dysfunction in liver transplant recipients is the careful management of immunosuppression. Important contributing factors to posttransplant renal dysfunction include pretransplant renal disease and immunosuppression, namely calcineurin inhibitors (CNIs). One of the most effective means of preventing posttransplant renal failure is observation of the defined criteria for selecting patients for SLK. In addition, avoidance and minimization of CNIs may help to mitigate posttransplant renal disease.