Kidney Biopsies May Help Predict Renal Function After Liver Transplantation

Pichler, Raimund; Huskey, Janna; Kowalewska, Jolanta; Moiz, Abdul; Perkins, James D.; Davis, Connie L.; Leca, Nicolae

doi:10.1097/tp.0000000000001334

Cited by 30 publications

(10 citation statements)

References 16 publications

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“…Renal biopsies can be useful to help determine reversibility of some types of renal failure; however, complications associated with these biopsies may prevent their widespread usage; thus, blood markers would be favorable. 35 While this is an exciting area of ongoing research, recent studies have failed to demonstrate an association between serum and urine biomarkers with renal function recovery, highlighting the importance of further multicenter studies to derive novel biomarkers, as they have a promising role as an adjunct in the determination of whether to proceed with SLK or LTA. 36-38…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Liver Transplantation in Patients on Renal Replacement Therapy: Considerations for Simultaneous Liver Kidney Transplantation Versus Safety Net

Pita

Kaur

Emamaullee

et al. 2019

Transplantation Direct

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What problem will this proposal solve? Current OPTN policy prioritizes candidates seeking a simultaneous liver kidney (SLK) transplant before pediatric and adult transplant candidates who are listed only for a kidney ("kidney alone candidates") when the liver candidate and the deceased donor are in the same Donation Service Area (DSA) 1. Unlike kidney alone allocation, in SLK allocation, the kidney is not allocated based on medical criteria assessing the kidney function of the candidate. Instead, geographic proximity between the liver-kidney candidate and the donor is the single factor in allocating the kidney with the liver. OPOs are not required to allocate the kidney with the liver regionally, although they are given the discretion to do so. The Kidney Transplantation Committee ("the Committee"),has identified several problems with this current policy:

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Section: Discussionmentioning

confidence: 99%

Outcomes of Liver Transplantation in Patients on Renal Replacement Therapy: Considerations for Simultaneous Liver Kidney Transplantation Versus Safety Net

Pita

Kaur

Emamaullee

et al. 2019

Transplantation Direct

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“…The inability to accurately classify AKI into HRS versus an intrarenal aetiology and acute tubular necrosis (ATN) is a major factor for heterogeneity in SLK allocation . Renal biopsy is the gold standard for diagnosis of structural damage to kidneys . However, this is rarely performed in clinical practice, especially among patients with cirrhosis and liver failure because of the risk of bleeding .…”

Section: Reasons For Heterogeneity In Allocation Of Slk Transplantationmentioning

confidence: 99%

Simultaneous liver kidney transplantation

et al. 2019

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Summary Kidney injury is frequently seen in patients with end‐stage liver disease from cirrhosis and liver failure. Among selected patients, simultaneous liver kidney (SLK) transplantation provides improved post‐transplant graft and patient outcomes compared to liver transplantation (LT) alone. We conducted the review of the existing literature on SLK transplant criteria and outcomes. Since the introduction of the model for end‐stage disease (MELD) score in 2002, there has been an increased use of SLK transplantation. The criteria for SLK allocation are relatively homogeneous among patients with end‐stage renal disease with cirrhosis and among patients with cirrhosis and chronic kidney disease. However, these are quite heterogeneous among patients with cirrhosis and acute kidney injury (AKI), mainly because of inability to accurately differentiate cause of AKI, especially hepatorenal syndrome versus intrarenal aetiology. Clearly, there is an unmet need of urine biomarkers of tubular injury and/or clinical models to accurately stratify AKI aetiology and to predict renal recovery after LT as basis to best utilize the scarce donor kidney pool. In this regard, it remains to be seen whether recently implemented policies by the organ procurement transplant network can fulfil the goal of saving donor kidneys and optimal allocation of SLK.

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“…While native kidney biopsy has been investigated as a potential means of identifying patients in need of a combined liver and kidney transplant rather than a liver-alone transplant, data on this are limited. [119][120][121] It should be considered in select patients at low risk of kidney biopsy-related complications to make a decision regarding combined liver and kidney transplant versus liver-alone transplant.…”

Section: Clinical Utilitymentioning

confidence: 99%

KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Puttarajappa

Schinstock

et al. 2021

American Journal of Kidney Diseases

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Evaluation of patients for kidney transplant candidacy is a comprehensive process that involves a detailed assessment of medical and surgical issues, psychosocial factors, and patients' physical and cognitive abilities with an aim of balancing the benefits of transplantation and potential risks of surgery and long-term immunosuppression. There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation-Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges. The KDOQI work group agrees broadly with the KDIGO recommendations but also recognizes and highlights the decision-making challenges that arise from lack of high-quality evidence and the need to balance equity with utility of organ transplantation.Because they are designed to reflect the views and recommendations of the responsible KDOQI Commentary work group and they are reviewed and approved by KDOQI and NKF leadership, KDOQI Commentaries are not peer reviewed by AJKD. This article was prepared by a KDOQI Commentary work group comprising the authors and chaired by Dr Sundaram Hariharan. It was reviewed and approved by the NKF Scientific Advisory Board and the KDOQI Chair and Vice Chairs.Complete author and article information provided before references.

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Kidney Biopsies May Help Predict Renal Function After Liver Transplantation

Abstract: Renal biopsy can be relatively safe in this population, may help elucidate the etiology of renal failure, may predict post-LAT kidney function, and may be helpful in kidney allocation for liver transplant candidates.

Cited by 30 publications

References 16 publications

Outcomes of Liver Transplantation in Patients on Renal Replacement Therapy: Considerations for Simultaneous Liver Kidney Transplantation Versus Safety Net

Outcomes of Liver Transplantation in Patients on Renal Replacement Therapy: Considerations for Simultaneous Liver Kidney Transplantation Versus Safety Net

Simultaneous liver kidney transplantation

KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

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