Yenebere Priya, Kubal Chandrashekhar A, Jan Muhammad Yahya
Division of Nephrology, Department of Medicine, Indiana University School of Medicine.
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Curr Opin Organ Transplant. 2025 Apr 1;30(2):152-157. doi: 10.1097/MOT.0000000000001194. Epub 2024 Dec 12.
Highlight the importance of acute kidney injury (AKI) among liver transplant candidates, its importance of survival and the vital role of continuous renal replacement therapy (CRRT) as a supportive therapy.
Kidney dysfunction is common in the preliver transplant patient. Early recognition, broad diagnostic work up, and therapeutic interventions are vital in minimizing morbidity and mortality in this critically ill group of patients. Liver dysfunction can impact kidney function in multiple ways, leading to worsening of clinical illness. High mortality and poor prognosis in those with AKI without CRRT and Liver Transplant are highlighted.
Etiology of AKI may not be as important as is the potential for liver transplant (LT) listing in offering CRRT. Non eligibility for a LT does not by default imply non eligibility for CRRT. Multidisciplinary approach should be adopted among those with a need for CRRT in the setting of end-stage liver disease. Goals of care conversations are key, in evaluating the role of CRRT in this group of individuals as they have a very high risk of mortality.
强调急性肾损伤（AKI）在肝移植候选者中的重要性、其对生存的重要性以及连续性肾脏替代疗法（CRRT）作为一种支持性治疗的关键作用。
肾功能不全在肝移植术前患者中很常见。早期识别、全面的诊断检查以及治疗干预对于将这一危重症患者群体的发病率和死亡率降至最低至关重要。肝功能障碍可通过多种方式影响肾功能，导致临床病情恶化。强调了未接受CRRT和肝移植的AKI患者的高死亡率和不良预后。
在提供CRRT方面，AKI的病因可能不如肝移植（LT）列入名单的可能性重要。不符合LT标准并不默认意味着不符合CRRT标准。对于终末期肝病需要CRRT的患者，应采用多学科方法。护理目标对话很关键，有助于评估CRRT在这类个体中的作用，因为他们的死亡风险非常高。
