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World J Transplant. Jun 18, 2026; 16(2): 115035
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115035
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115035
Rethinking chronic kidney disease risk after liver transplantation
Concetto Sessa, Walter Morale, Department of Nephrology and Dialysis, Maggiore “Nino Baglieri” Hospital, 97015 Modica (RG), Sicily, Italy
Guido Gembillo, Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, University of Messina, Messina 90125, Italy
Co-first authors: Concetto Sessa and Guido Gembillo.
Author contributions: Gembillo G and Morale W were responsible for the conception of the study and supervision; Gembillo G and Sessa C were responsible for the design, the writing, the literature review, and the critical review of the manuscript; they contributed equally to this article, and they are the co-first authors of this manuscript. All authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Concetto Sessa, MD, Department of Nephrology and Dialysis, Maggiore “Nino Baglieri” Hospital, Via Aldo Moro 1, 97015 Modica (RG), Sicily, Italy.
Received: October 9, 2025
Revised: December 11, 2025
Accepted: January 19, 2026
Published online: June 18, 2026
Processing time: 235 Days and 15.6 Hours
Revised: December 11, 2025
Accepted: January 19, 2026
Published online: June 18, 2026
Processing time: 235 Days and 15.6 Hours
Core Tip
Core Tip: Chronic kidney disease following liver transplantation is a critical, modifiable determinant of long-term survival. Its pathogenesis extends beyond calcineurin inhibitor (CNI) toxicity to include pre-transplant renal dysfunction, perioperative acute kidney injury, and metabolic comorbidities like hypertension. Consequently, shifting focus toward early nephroprotection is essential. Evidence supports a multi-pronged approach: proactive perioperative hemodynamic management, the use of basiliximab induction to safely delay CNI exposure, mycophenolate-based CNI minimization, and aggressive metabolic control. These strategies significantly enhance long-term renal preservation without compromising graft integrity.