Department of Medicine, University of California Los Angeles, Los Angeles, California.
Department of Medicine, Centura Health, Denver, Colorado.
Curr Opin Nephrol Hypertens. 2024 May 1;33(3):354-360. doi: 10.1097/MNH.0000000000000970. Epub 2024 Feb 12.
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.
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.
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.
在确定肝移植候选者的肾功能是否可逆时，肾功能障碍具有挑战性。本综述重点介绍了在实施肝肾联合（SLK）分配政策和安全网后，如何在当前时代最好地处理伴有肾功能障碍的肝移植候选者的相关数据。
SLK 政策的实施扭转了 SLK 移植稳步上升的趋势，并提高了高质量肾脏的利用率。与单独肝移植（LTA）相比，接受肾移植的机会增加，且结果良好。在肝移植候选者中估算肾小球滤过率仍然具有挑战性，需要创新方法。对于至少接受 3 个月透析的晚期 CKD 患者，SLK 与仅 LTA 相比，为患者和移植物提供了更好的生存优势。SLK 可为高度致敏候选者提供针对肾脏排斥的免疫保护。SLK 后移植护理复杂，并发症和住院风险增加。
SLK 政策改善了肾脏的可及性和利用率。在安全网下，鼓励移植中心为至少接受 3 个月透析的晚期 CKD 或透析的肝移植候选者保留 SLK，同时为高度致敏患者放宽阈值。在此，我们提出了一种针对伴有肾功能障碍的肝移植候选者的实用方法。
