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Review
. 2015 Sep;22(5):391-8.
doi: 10.1053/j.ackd.2015.05.002.

Kidney Failure and Liver Allocation: Current Practices and Potential Improvements

Varun Saxena  1 , Jennifer C Lai  2
Affiliations
Review

Kidney Failure and Liver Allocation: Current Practices and Potential Improvements

Varun Saxena et al. Adv Chronic Kidney Dis. 2015 Sep.

Abstract

In February 2002, the United Network for Organ Sharing implemented a system for prioritizing candidates for liver transplantation that was based on the risk of 90-day mortality as determined by the Model for End-Stage Liver Disease (MELD) score. As the MELD score is driven in part by serum creatinine as a marker of kidney function, the prevalence of kidney dysfunction and failure in patients with end-stage liver disease at the time of listing and at transplantation has steadily risen. In this review, we discuss current practices in liver transplantation in patients with kidney dysfunction focusing briefly on the decision to perform simultaneous liver-kidney transplantation. We then discuss pitfalls to the current practices of liver transplantation in patients with kidney dysfunction. We conclude by discussing potential improvements to current practices including the use of the MELD-Na score, alternatives to creatinine and creatinine-based equation for estimating kidney function, and the use of intraoperative kidney replacement therapy during liver transplantation.

Keywords: Acute kidney injury; Biomarkers; Creatinine; Liver transplant; Model for end-stage liver disease.

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Figures

Figure 1
Figure 1. Number of and Percentage of Simultaneous Liver-Kidney Transplants (SLK) by Year
Based on United Network of Organ Sharing (UNOS) data abstracted February 2014
Figure 2
Figure 2. An Algorithm to Evaluate a Liver Transplant Candidate with Renal Dysfunction for Simultaneous Liver-Kidney Transplant (SLK),
See this image and copyright information in PMC

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