Management of renal dysfunction in the liver transplant recipient.
OBJECTIVE
Acute and chronic kidney injury following orthotopic liver transplantation (OLT) is associated with increased morbidity and mortality. With the increasing longevity of liver transplant recipients, chronic kidney disease (CKD) has become an increasingly prevalent complication among long-term survivors. This article provides an overview of the literature on suggested risk factors for acute and CKD following OLT and a discussion of an approach to their medical management.


RESULTS
In OLT candidates with pretransplant renal dysfunction, the use of interleukin-2 receptor blockers or antithymocyte globulin induction therapy in conjunction with delayed introduction of calcineurin inhibitors may preserve early renal function. In long-term stable OLT recipients with established calcineurin inhibitor nephrotoxicity, calcineurin inhibitor minimization or withdrawal protocols may halt or ameliorate renal dysfunction without compromising patient and graft survival. However, large-scale, multicenter, randomized controlled trials are still needed.


CONCLUSIONS
The occurrence of acute kidney injury is common immediately after OLT, whereas the incidence of CKD and end-stage renal disease increases with time. Identifying patients at risk for acute kidney injury and CKD following OLT and early implementation of measures to preserve, halt, or ameliorate the progression of renal dysfunction should be an integral part in the management of OLT recipients.
Pham
Phuong-Thu T
PT
Nephrology Division, Department of Medicine, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Pham
Phuong-Chi T
PC
Wilkinson
Alan H
AH
D000208:Acute Disease; D002908:Chronic Disease; D018450:Disease Progression; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents