Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2022; 14(1): 45-61
Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.45
Current aspects of renal dysfunction after liver transplantation
Mariana P Pacheco, Luiz Augusto Carneiro-D'Albuquerque, Daniel F Mazo
Mariana P Pacheco, Daniel F Mazo, Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Sao Paulo, Brazil
Luiz Augusto Carneiro-D'Albuquerque, Division of Digestive Organs Transplant, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Sao Paulo, Brazil
Daniel F Mazo, Division of Gastroenterology, Department of Internal Medicine, School of Medical Sciences of University of Campinas, Campinas 13083-878, Sao Paulo, Brazil
Author contributions: Pacheco MP and Mazo DF conceived the idea, conducted the literature review, and wrote the manuscript; Carneiro-D'Albuquerque LA critically reviewed the manuscript; and all authors approved the final version of the manuscript for publication.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel F Mazo, MD, PhD, Professor, Staff Physician, Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar nº 255, Instituto Central, # 9159, Sao Paulo 05403-900, Sao Paulo, Brazil. daniel.mazo@hc.fm.usp.br
Received: February 24, 2021
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
Abstract

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.

Keywords: Liver transplantation, Acute kidney injury, Chronic kidney disease, Calcineurin inhibitor, Mycophenolic acid, Everolimus

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.