Novel indications for referral and care for simultaneous liver kidney transplant recipients.

IF 2.2 3区医学 Q3 PERIPHERAL VASCULAR DISEASE Current Opinion in Nephrology and Hypertension Pub Date : 2024-05-01 Epub Date: 2024-02-12 DOI:10.1097/MNH.0000000000000970

Erik L Lum, Suphamai Bunnapradist, Alexander C Wiseman, Ahmet Gurakar, Antoney Ferrey, Uttam Reddy, Fawaz Al Ammary

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Abstract

Purpose of review: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net.

Recent findings: The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys. Access to kidney transplantation following liver transplant alone (LTA) increased with favorable outcomes. Estimating GFR in liver transplant candidates remains challenging, and innovative methods are needed. SLK provided superior patient and graft survival compared to LTA only for patients with advanced CKD and dialysis at least 3 months. SLK can provide immunological protection against kidney rejection in highly sensitized candidates. Post-SLK transplant care is complex, with an increased risk of complications and hospitalization.

Summary: The SLK policy improved kidney access and utilization. Transplant centers are encouraged, under the safety net, to reserve SLK for liver transplant candidates with advanced CKD or dialysis at least 3 months while allowing lower thresholds for highly sensitized patients. Herein, we propose a practical approach to liver transplant candidates with kidney dysfunction.

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肝肾同时移植受者转诊和护理的新适应症。

审查目的：在肝移植候选者中，肾功能障碍对确定其是否可逆具有挑战性。本综述重点关注在实施同步肝肾（SLK）分配政策和安全网后，如何在当前时代以最佳方式对待肾功能不全的肝移植候选者的相关数据：肝肾同时分配政策的实施扭转了肝肾同时移植数量持续上升的趋势，提高了高质量肾脏的利用率。单纯肝移植（LTA）后进行肾移植的机会增加，结果良好。估算肝移植候选者的肾小球滤过率仍然具有挑战性，需要创新的方法。对于晚期慢性肾功能衰竭且透析至少 3 个月的患者，SLK 的患者存活率和移植物存活率均优于 LTA。SLK可为高度致敏的候选者提供免疫保护，防止肾脏排斥反应。SLK移植后的护理非常复杂，并发症和住院风险增加。安全网鼓励移植中心为晚期慢性肾功能衰竭或透析至少 3 个月的肝移植患者保留 SLK，同时降低高度敏感患者的阈值。在此，我们提出了一种针对肾功能不全的肝移植候选者的实用方法。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.

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