Renal dysfunction in patients with cirrhosis: Where do we stand?

Table 7 Published guidelines on selection criteria for simultaneous liver-kidney transplantation

Davis et al[121], 2007

Patients with CKD with CrCl (preferentially iothalamate) of ≤ 30 mL/min for > 3 mo

Patients with AKI and/or HRS on dialysis for ≥ 6 wk

Patients with prolonged AKI with kidney biopsy showing fixed renal damage

SLK was not recommended in patients with AKI not requiring dialysis

Eason et al[122], 2008

Patients with CKD with GFR ≤ 30 mL/min > 3 mo

Patients with AKI/HRS with sCr ≥ 2 mg/dL and on dialysis ≥ 8 wk

Patients with evidence of CKD and kidney biopsy with > 30% GS or 30% fibrosis

Other criteria that was recommended to be considered: Presence of co-morbidities: Diabetes, Hypertension, age > 65 yr, renal size and duration of sCr > 2 mg/dL

Nadim et al[123], 2012

Persistent AKI ≥ 4 wk with one of the following:

Increase Scr ≥ 3-fold from baseline or on dialysis

GFR ≤ 35 mL/min (MDRD-6) or ≤ 25 mL/min (iothalamate)

CKD ≥ 3 mo with one of the following:

eGFR ≤ 40 mL/min (MDRD-6) or ≤ 30 mL/min (iothalamate)

Proteinuria ≥ 2 g/d

Kidney biopsy showing > 30% GS or > 30% interstitial fibrosis

Note: Higher GFR threshold with MDRD-6 was to account for the approximate 30%- 40% overestimation that has been described when compared to iothalamate.

CKD: Chronic kidney disease; CrCl: Creatinine clearance; HRS: Hepatorenal syndrome; AKI: Acute kidney injury; SLK: Simultaneous Liver-Kidney; sCr: Serum creatinine; GFR: Glomerular filtration rate; GS: Glomerulosclerosis; MDRD-6: Modification of diet in renal disease formula calculated using six variables of serum creatinine, serum urea, serum albumin, age, gender.