Combined liver–kidney transplantation versus liver transplant alone based on
            <scp>KDIGO</scp>
            stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

Tinti, Francesca; Mitterhofer, Anna Paola; Umbro, I.; Inston, Nicholas; Ghallab, Mohammed; Ferguson, James; Mirza, Darius F.; Ball, Simon; Lipkin, Graham; Muiesan, Paolo; Perera, M. Thamara P. R.

doi:10.1111/tri.13413

Cited by 14 publications

(9 citation statements)

References 33 publications

(46 reference statements)

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“…The comparison of outcomes and post-transplant kidney function between patients who underwent kidney/liver transplant and liver transplant alone was made using eGFR stratification. Tinti and coworkers [ 47 ] analyzed the UK National Transplant Database (NHSBT) and evaluated 6035 patients receiving an LTA ( n = 5912; 98%) vs. CLKT ( n = 123; 2%); analysis was made after stratification by KDIGO stages of eGFR at transplant. No difference in patient and graft survival between LTA and CLKT patients in various eGFR group/strata occurred (NS).…”

Section: Hcc Chronic Kidney Disease and Interventional Management (3)mentioning

confidence: 99%

An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Fabrizi

Cerutti

Alfieri

et al. 2021

Cancers

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Chronic kidney disease is a major public health issue globally and the risk of cancer (including HCC) is greater in patients on long-term dialysis and kidney transplant compared with the general population. According to an international study on 831,804 patients on long-term dialysis, the standardized incidence ratio for liver cancer was 1.2 (95% CI, 1.0–1.4) and 1.5 (95% CI, 1.3–1.7) in European and USA cohorts, respectively. It appears that important predictors of HCC in dialysis population are hepatotropic viruses (HBV and HCV) and cirrhosis. 1-, 3-, and 5-year survival rates are lower in HCC patients on long-term dialysis than those with HCC and intact kidneys. NAFLD is a metabolic disease with increasing prevalence worldwide and recent evidence shows that it is an important cause of liver-related and extra liver-related diseases (including HCC and CKD, respectively). Some longitudinal studies have shown that patients with chronic hepatitis B are aging and the frequency of comorbidities (such as HCC and CKD) is increasing over time in these patients; it has been suggested to connect these patients to an appropriate care earlier. Antiviral therapy of HBV and HCV plays a pivotal role in the management of HCC in CKD and some combinations of DAAs (elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir-based regimens) are now available for HCV positive patients and advanced chronic kidney disease. The interventional management of HCC includes liver resection. Some ablative techniques have been suggested for HCC in CKD patients who are not appropriate candidates to surgery. Transcatheter arterial chemoembolization has been proposed for HCC in patients who are not candidates to liver surgery due to comorbidities. The gold standard for early-stage HCC in patients with chronic liver disease and/or cirrhosis is still liver transplant.

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Section: Hcc Chronic Kidney Disease and Interventional Management (3)mentioning

confidence: 99%

An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Fabrizi

Cerutti

Alfieri

et al. 2021

Cancers

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“…If sCr is decreased, the prognosis of transplantation can be improved [ 180 ]. If CRRT therapy was established at the time of liver transplantation, then the prognosis for transplantation alone was worsened [ 181 ]. Estimated glomerular filtration rate (GFR) of ≤35 mL/min or measured GFR of ≤25 mL/min for ≥4 weeks was an important criterion for combined liver–kidney transplantation [ 182 ].…”

Section: Treatment Of Hrs-aki With Aclfmentioning

confidence: 99%

Hepatorenal syndrome in acute-on-chronic liver failure with acute kidney injury: more questions requiring discussion

Liu

Meng

et al. 2021

Gastroenterology Report

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In cirrhosis with ascites, hepatorenal syndrome (HRS) is a specific prerenal dysfunction unresponsive to fluid volume expansion. Acute-on-chronic liver failure (ACLF) comprises a group of clinical syndromes with multiple organ failure and early high mortality. There are differences in the characterization of ACLF between the Eastern and Western medical communities. Patients with ACLF and acute kidney injury (AKI) have more structural injuries, contributing to confusion in diagnosing HRS-AKI. In this review, we discuss progress in the pathogenesis, diagnosis, and management of HRS-AKI, especially in patients with ACLF. Controversy regarding HRS-AKI in ACLF and acute liver failure, hepatic carcinoma, shock, sepsis, and chronic kidney disease is also discussed. Research on the treatment of HRS-AKI with ACLF needs to be more actively pursued to improve disease prognosis.

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“…Previous studies are focused on patients with the most impaired renal function, such as those with creatinine (Cr) ≥ 2.5 mg/dl or with a need for dialysis (10,11). There is scarce information regarding outcomes of patients with moderate renal impairment after LT, and the impact of liver disease etiology on renal function recovery has not been fully addressed (12). Presumably, a higher incidence of structural kidney injury in the NAFLD population and overestimation of renal function when using serum Cr, may lead to overlook a significant and irreversible renal impairment in this vulnerable group of patients (13).…”

Section: Introductionmentioning

confidence: 99%

“…In view of this, certain proposals have been made by the Organ Procurement and Transplantation Network (OPTN) to offer some guidance on SLKT allocation, resulting in the inclusion of the latest consensus in OPTN official policies of 2017 (24)(25)(26)(27)(28)(29)(30). These are valuable criteria, but they still lack solid demonstration of a benefit in survival, and other studies show that glomerular filtration rate (GFR) alone may not guide SLKT indication (12,31,32). New predictive factors are needed in order to better support the decision making process.…”

Section: Introductionmentioning

confidence: 99%

Poor Outcomes of Patients With NAFLD and Moderate Renal Dysfunction or Short-Term Dialysis Receiving a Liver Transplant Alone

Fernández-Carrillo

Li²,

Ventura‐Cots³

et al. 2022

Transpl Int

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The outcomes of patients with moderate renal impairment and the impact of liver disease etiology on renal function recovery after liver transplant alone (LTA) are largely unknown. We explored whether NAFLD patients with pre-LTA moderate renal dysfunction (GFR 25–45 ml/min/1.73 m2) may be more susceptible to develop post-LTA severe renal dysfunction (GFR<15 ml/min/1.73 m2) than ALD patients, as well as other overall outcomes. Using the UNOS/OPTN database, we selected patients undergoing liver transplant for NAFLD or ALD (2006–2016), 15,103 of whom received LTA. NAFLD patients with moderate renal dysfunction were more likely to develop subsequent GFR<15 ml/min/1.73 m2 than ALD patients (11.1% vs. 7.38%, p < 0.001). Patients on short-term dialysis pre-LTA (≤12 weeks) were more likely to develop severe renal dysfunction (31.7% vs. 18.1%), especially in NAFLD patients, and were more likely to receive a further kidney transplant (15.3% vs. 3.7%) and had lower survival (48.6% vs. 50.4%) after LTA (p < 0.001 for all). NAFLD was an independent risk factor for post-LTA severe renal dysfunction (HR = 1.2, p = 0.02). NAFLD patients with moderate renal dysfunction and those receiving short-term dialysis prior to LTA are at a higher risk of developing subsequent severe renal dysfunction. Underlying etiology of liver disease may play a role in predicting development and progression of renal failure in patients receiving LTA.

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Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

Cited by 14 publications

References 33 publications

An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Hepatorenal syndrome in acute-on-chronic liver failure with acute kidney injury: more questions requiring discussion

Poor Outcomes of Patients With NAFLD and Moderate Renal Dysfunction or Short-Term Dialysis Receiving a Liver Transplant Alone

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