Care of the Liver Transplant Recipient
Management of Renal Function
Summary
One consequence of improved survival following liver transplant (LT) is an aging cohort of recipients at risk of renal dysfunction due to nephrotoxic immunosuppressive agents. Metabolic complications such as hypertension, diabetes mellitus, hyperlipidemia, and obesity are common and may contribute to renal disease. Serum creatinine as a measure of renal function has important limitations. Renal dysfunction frequently occurs in patients with decompensated cirrhosis and its prognostic significance is reflected by inclusion of serum creatinine in the Model for End-Stage Liver Disease. Acute kidney injury (AKI) occurs postoperatively in 17-95% of LT recipients, with the wide range mainly reflecting the lack of a standardized definition of AKI. Post-transplant diabetes associated with long-term use of calcineurin inhibitors (CNIs) increases the risk of renal dysfunction. Systemic hypertension is evident typically early after initiation of CNI therapy. Delayed introduction of CNIs is an attractive therapeutic strategy for patients with renal dysfuncti.