Updates, predictors & benefits of early diagnosis & management of acute kidney injury in post liver transplant patient

Abstract

SUMMARY L iver transplantation is a treatment, used in appropriately selected patients, for acute and chronic liver failure due to any cause. It is not indicated if an acceptable alternative is available or if contraindications, such as some cases of malignancy, terminal conditions, or poor expected quality of outcome, are present. Acute kidney injury is one of the most common complications of liver transplantation. It occurs more frequently in those who have hepatorenal syndrome at the time of liver transplantation. Acute renal dysfunction has been associated with an 8-fold increase in mortality risk, prolonged intensive care unit stay and a greater risk for Infectious complications. Chronic renal dysfunction, not only has implications in terms of an increased demand on resources, but is also significantly associated with a higher patient mortality rate. In order to minimize the occurrence of ARD and CRD thereafter, it is vital to define the possible preoperative, intraoperative and postoperative risk factors. The duration of pre transplantation renal dysfunction and the occurrence of post transplantation acute kidney injury has significant unfavorable impact on the survival rate after liver transplantation operation. For both prognostic and therapeutic reasons it is important to assess the level of renal function in patients being considered for liver transplantation and to determine if there is any reversible component. Also given organ shortage it should be essential to determine which patients will experience progressive and severe renal dysfunction after liver transplantation. Because limitations of AKIN criteria, it is now attempted to find new biomarkers released by the renal tubules, which (if increased in urine or blood serum) would allow for an early diagnosis of AKI or identification of a group at increased risk of AKI. The most frequently mentioned indicators of this type include:cystatin C,N-GAL,KIM-1. To prevent acute kidney injury effectively, it is necessary to know its risk factors, to evaluatethe patient in detail before liver transplantation, and to obey the rules of conduct, characteristic for all clinical situations that could lead to AKI development. There is no specific management for the vast majority of patients with established AKI. Patients with prerenal azote¬mia should have intravascular volume deficits corrected and cardiac function optimized. Once AKI has developed and treat¬able or reversible causes have been excluded, the general. Opti¬mization of extracellular fluid volume status, cardiac index, and maintenance of perfusion and oxygenation of vital organs are considered first. Careful monitoring of clinical and biochemical parameters and drug levels is indicated, especially for agents with narrow therapeutic indices that are eliminated by the kidneys. In addition, further dosage adjustments may be required when renal replacement therapy is provided, espe-cially for antibiotics to ensure that adequate therapeutic levels are achieved. In patients with severe AKI, renal replacement therapy (RRT) is the cornerstone of supportive management. The goal of renal replacement therapy is to permit the removal of fluids and solutes that accumulate in renal failure, thereby restoring the composition and volume of the extracellular fluids and preventing the complications of uremia.