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Renal Failure and Liver Allocation: Current Practices and Potential Improvements #MMPMID26311601
Saxena V; Lai JC
Adv Chronic Kidney Dis 2015[Sep]; 22 (5): 391-8 PMID26311601show ga
In February 2002, the United Network for Organ Sharing implemented a system for prioritizing candidates for liver transplantation that was based on the risk of 90-day mortality as determined by the Model for End-Stage Liver Disease (MELD) score. As the MELD score is driven in part by serum creatinine as a marker of renal function, the prevalence of renal dysfunction and failure in patients with end-stage liver disease (ESLD) at the time of listing and at transplantation has steadily risen. In this review, we discuss current practices in liver transplantation in patients with renal dysfunction focusing briefly on the decision to perform simultaneous liver-kidney (SLK) transplantation. We then discuss pitfalls to the current practices of liver transplantation in patients with renal dysfunction. We conclude by discussing potential improvements to current practices including the use of the MELD-sodium score, alternatives to creatinine and creatinine-based equation for estimating renal function and the use of intraoperative renal replacement therapy during liver transplantation.