Analysis of Kidney Function and Biopsy Results in Liver Failure Patients With Renal Dysfunction: A New Look to Combined Liver Kidney Allocation in the Post-MELD Era

Abstract

The workup algorithm, which primarily uses duration of renal failure, glofil measurement, and renal biopsy findings, offers a practical approach to this complicated decision-making process regarding appropriate allocation of organs for CLKT.

Performance of Methods to Assess Kidney Function in a Predominantly Overweight Sample of Patients with Liver Disease

“…12 The use of GFR to assess kidney function has been proposed as a more reliable means of evaluating mortality risk and the need for CLKT in patients with liver disease as opposed to the use of SCr alone in calculating the MELD score. 4,41,42 While this approach may be reasonable, the variable performance of the MDRD, CG, and cystatin C-based methods calls into question the adoption of estimating equations for the purpose of determining GFR to make such important decisions regarding transplantation. There is also a concern that inaccurate assessment of GFR will lead to inappropriate dosing of medications that are renally eliminated and increase the potential for adverse drug events.…”

“…3 With limited organ availability, the use of the MELD alone to prioritize CLKT has been questioned and prompted some transplant centers to evaluate other methods, including the measurement of glomerular filtration rate (GFR). 4 GFR can be quantified by a direct measurement or estimated using assessment equations. The gold-standard method is to measure clearance of a substance exclusively filtered, such as inulin or the radiolabeled markers iodine 125-labeled iothalamate ( Cr-EDTA clearance values measured using the plasma decay method have been shown to overestimate GFR in patients with liver disease and concomitant ascites or edema due to extrarenal clearance of the exogenous markers.…”

Kidney Disease in Liver, Cardiac, Lung, and Hematopoietic Cell Transplantation

“…Single-center studies suggest that use of a combination of clinical and histologic criteria allows effective prediction of which patients will benefit most from simultaneous liverkidney transplantation. 20,21 These centers used iothalamate clearance to measure GFR in patients with suspected AKI. Renal biopsy was performed by the percutaneous or transjugular method and had a moderate rate of complications 20,21 ; some believe that it adds little discriminating value.…”

Renal Dysfunction in Liver Transplant Candidates: Evaluation, Classification and Management in Contemporary Practice

“…In a study by Tanriover et al [75], patients with prolonged renal dysfunction, as estimated by serum creatinine and confirmed by direct measurement of the GFR using the iodine-125 iothalamate test, was recommended for renal biopsy. Patients with findings of advanced intrinsic kidney disease (interstitial fibrosis greater than 30%, glomerular sclerosis greater than 40%, or moderate to severe arteriosclerosis) were recommended for SLK transplant.…”

“…Because renal biopsy has been shown to be safe and effective in patients with liver failure, it has been utilized for SLK transplant evaluation in some centers [42,75] and recommended by the UNOS guidelines for dual listing. In a study by Tanriover et al [75], patients with prolonged renal dysfunction, as estimated by serum creatinine and confirmed by direct measurement of the GFR using the iodine-125 iothalamate test, was recommended for renal biopsy.…”