Kidn ey Protection during Liver Transplantation

Abstract

SUMMARY L iver transplantation carries a major risk for development of kidney dysfunction. Multiple risk factors contribute to renal affection during the operation. Identification of those risk factors and their proper management can help to protect the renal functions from being affected. The main risk factors are classified to preoperative, intraoperative and postoperative risk factors. Collectively they include preoperative renal affection, hepatorenal syndrome, contrast induced nephropathy, intraoperative hemodynamic instability, the surgical technique used, the need for massive blood transfusion, postoperative sepsis, use of nephrotoxic Calcineurin inhibitor and graft rejection. Strategies have been developed to help in kidney protection during the operation include: 1) Proper management of sepsis 2) Using of vasopressor, TIPS and renal replacement therapy in hepato-renal syndrome 3) Keeping hemodynamics stability during the operation 4) Using of the piggy back surgical technique 5) Optimizing the usage of immunosuppressants 6) Renal replacement therapy if needed