Current aspects of renal dysfunction after liver transplantation

Table 1 Main causes of kidney dysfunction in liver transplantation according to the period of its occurrence

Pre-transplantation	Perioperative	After transplantation
Hypovolemia; Infections; Nephrotoxic drugs; Hepatorenal syndrome; High MELD; NASH/MAFLD; Renal parenchymal diseases associated with hepatitis B, C and alcohol	Hemodynamic instability; Reperfusion injury; Nephrotoxic drugs	Calcineurin inhibitors; Diabetic nephropathy; Hypertensive nephropathy

MELD: Model for end-stage liver disease; NASH: Non-alcoholic steatohepatitis; MAFLD: Metabolic dysfunction-associated fatty liver disease.

Table 2 Main formulas for measurement of glomerular filtration rate

Formulas
Cockcroft Gault	[(140 – age) × weight]/[(72 × Scr) × (0.85 if female)]
MDRD 4	175 × (Scr)-1.154 × (age)-0.203 × (0.742 if female) × (1.212 if black)
MDRD 6	198 × (Scr)-0.858 × (age)-0.1678 × (0.822 if female) × (1.178 if black) × (Ur)-0.293 × (urine urea nitrogen excretion g/d)0.249
CKD-EPI creatinine equation	141 × min (creat/κ, 1)α × max (creat/κ, 1)-1.209 × 0.993age × (1.018 if female) × (1.159 if black)

Age in years; Weight in kg; κ is 0.7 for females and 0.9 for males; α is -0.329 for females and -0.411 for males. MDRD: Modification of diet in renal disease; CKD-EPI: Chronic kidney disease epidemiology collaboration; Scr: Serum creatinine; Ur: Urea concentration; Min: Minimum of creat/κ or 1; Max: Maximum of creat/κ or 1.

Table 3 Referral to specialized kidney care services

Indication
AKI or abrupt sustained fall in GFR
GFR < 30 mL/min/1.73 m²
Consistent significant albuminuria (albumin/creatinine ratio ≥ 300 mg/g or albumin excretion rate ≥ 300 mg/24 h, equivalent to protein/creatinine ratio ≥ 500 mg/g or protein excretion rate ≥ 500 mg/24 h)
Progression of CKD (a drop in GFR from baseline by 25% or a sustained decline in GFR of more than 5 mL/min/1.73 m2/yr)

AKI: Acute kidney injury; GFR: Glomerular filtration rate; CKD: Chronic kidney disease.