Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.45
Peer-review started: February 24, 2021
First decision: October 17, 2021
Revised: October 24, 2021
Accepted: January 6, 2022
Article in press: January 6, 2022
Published online: January 27, 2022
Processing time: 330 Days and 10.9 Hours
The development of chronic kidney disease (CKD) after liver transplantation (LT) exerts a severe effect on the survival of patients. The widespread adoption of the model for end-stage liver disease score strongly impacted CKD incidence after the procedure, as several patients are transplanted with previously deteriorated renal function. Due to its multifactorial nature, encompassing pre-transplantation conditions, perioperative events, and nephrotoxic immunosuppressor therapies, the accurate identification of patients under risk of renal disease, and the implementation of preventive approaches, are extremely important. Methods for the evaluation of renal function in this setting range from formulas that estimate the glomerular filtration rate, to non-invasive markers, although no option has yet proved efficient in early detection of kidney injury. Considering the nephrotoxicity of calcineurin inhibitors (CNI) as a factor of utmost importance after LT, early nephroprotective strategies are highly recommended. They are based mainly on delaying the application of CNI during the immediate postoperative-period, reducing their dosage, and associating them with other less nephrotoxic drugs, such as mycophenolate mofetil and everolimus. This review provides a critical assessment of the causes of renal dysfunction after LT, the methods of its evaluation, and the interventions aimed at preserving renal function early and belatedly after LT.
Core Tip: Post-liver transplantation renal dysfunction is a frequent complication that has a major impact on the survival rate of the graft and the patient. Due to the multifactorial nature of post-transplantation chronic kidney disease, the ability to accurately identify patients under risk and the development of preventive approaches are paramount. This review presents the state-of-the-art on the topic: Its causes, renal function assessment methods, and the most studied nephroprotective strategies.