Clinical practice guidelines for kidney injury management of liver transplant recipients in China(2023 edition)

doi:10.3877/cma.j.issn.2095-3232.2024.03.005

Abstract

Abstract:

Kidney injury is a common complication after liver transplantation, including acute kidney injury and chronic kidney disease. Kidney injury in liver transplant recipients seriously affects their long-term survival and life quality, and is one of the main causes of death after liver transplantation. In order to standardize and optimize the diagnosis and treatment of kidney injury in liver transplant recipients, Branch of Organ Transplant of Chinese Medical Association and Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize experts to develop the "Clinical Practice Guidelines for Kidney Injury Management of Liver Transplant Recipients in China (2023 Edition)" to adapt to the rapid development of diagnosis and treatment. The guideline is based on "Chinese expert consensus on management of kidney injury in liver transplant recipients (2017 edition)" and in conjunction with recent evidence-based medicine and clinical practice experience in China. This guideline focuses on the definition, classification, assessment and preoperative, intraoperative and postoperative prevention and treatments of kidney injury in liver transplant recipients. By presenting a series of scientifically standardized recommendations, the guideline is aimed to optimize the management of kidney injury in liver transplant recipients in China.

Key words: Liver transplantation, Acute kidney injury, Chronic kidney disease, Kidney injury management

Branch of Organ Transplant of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association. Clinical practice guidelines for kidney injury management of liver transplant recipients in China(2023 edition)[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 276-288.

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URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2024.03.005

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References 131

[1]	Minjares RO, Martin P, Carrion AF. Chronic kidney disease after liver transplantation[J]. Clin Liver Dis, 2022, 26(2):323-340.
[2]	Rasaei N, Malekmakan L, Mashayekh M, et al. Chronic kidney disease following liver transplant: associated outcomes and predictors[J]. Exp Clin Transplant, 2022, 21(2):93-103.
[3]	Jadlowiec CC, Taner T. Liver transplantation: current status and challenges[J]. World J Gastroenterol, 2016, 22(18):4438-4445.
[4]	Pacheco MP, Carneiro-D'Albuquerque LA, Mazo DF. Current aspects of renal dysfunction after liver transplantation[J]. World J Hepatol, 2022, 14(1):45-61.
[5]	Thongprayoon C, Kaewput W, Thamcharoen N, et al. Incidence and impact of acute kidney injury after liver transplantation: a meta-analysis[J]. J Clin Med, 2019, 8(3):372.
[6]	Miyata H, Morita Y, Kumar A. A systematic review of the literature on chronic kidney disease following liver transplantation[J]. Ann Transplant, 2022, 27: e935170.
[7]	Peng JC, Li YJ, Wang J, et al. Incidence of chronic kidney disease after orthotopic liver transplantation in a Chinese cohort[J]. Clin Exp Nephrol, 2020, 24(9):806-812.
[8]	Fabrizi F, Dixit V, Martin P, et al. Chronic kidney disease after liver transplantation: recent evidence[J]. Int J Artif Organs, 2010, 33(11):803-811.
[9]	Shetty A, Kodali S. Long-term management of the successful adult liver transplant: a patient-friendly summary of the 2012 AASLD and AST practice guideline[J]. Clin Liver Dis, 2022, 19(3):83-88.
[10]	Lucey MR, Terrault N, Ojo L, et al. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation[J]. Liver Transpl, 2013, 19(1):3-26.
[11]	McGuire BM, Rosenthal P, Brown CC, et al. Long-term management of the liver transplant patient: recommendations for the primary care doctor[J]. Am J Transplant, 2009, 9(9):1988-2003.
[12]	Allen AM, Kim WR, Therneau TM, et al. Chronic kidney disease and associated mortality after liver transplantation--a time-dependent analysis using measured glomerular filtration rate[J]. J Hepatol, 2014, 61(2):286-292.
[13]	中国医师协会器官移植医师分会，中华医学会器官移植学分会肝移植学组. 中国肝移植受者肾损伤管理专家共识(2017版)[J]. 中华消化外科杂志, 2017, 16(4):319-326.
[14]	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations[J]. BMJ, 2004, 328(7454):1490.
[15]	Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group[J]. BMC Health Serv Res, 2004, 4(1):38.
[16]	兰平，何晓生. 临床实践指南的制定流程与规范[J]. 中华胃肠外科杂志, 2022, 25(1):10-14.
[17]	Angeli P, Garcia-Tsao G, Nadim MK, et al. News in pathophysiology, definition and classification of hepatorenal syndrome: a step beyond the International Club of Ascites (ICA) consensus document[J].J Hepatol, 2019, 71(4):811-822.
[18]	Parajuli S, Foley D, Djamali A, et al. Renal function and transplantation in liver disease[J]. Transplantation, 2015, 99(9):1756-1764.
[19]	Park CS, Yoon YI, Kim N, et al. Analysis of outcomes and renal recovery after adult living-donor liver transplantation among recipients with hepatorenal syndrome[J]. Am J Transplant, 2022, 22(10):2381-2391.
[20]	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4):c179-184.
[21]	Martin LG, Vazquez-Garza JN, Grande AM, et al. Postreperfusion syndrome in liver transplant: a risk factor for acute kidney failure: a retrospective analysis[J]. Transplant Proc, 2022, 54(8):2277-2284.
[22]	董绉绉，石林惠，叶龙强, 等. 肝移植术后肾脏替代治疗的危险因素分析及初始治疗时机对预后的影响[J]. 中华危重病急救医学, 2018, 30(11):1056-1060.
[23]	Klaus F, Keitel da Silva C, Meinerz G, et al. Acute kidney injury after liver transplantation: incidence and mortality[J]. Transplant Proc, 2014, 46(6):1819-1821.
[24]	Barreto AG, Daher EF, Silva Junior GB, et al. Risk factors for acute kidney injury and 30-day mortality after liver transplantation[J]. Ann Hepatol, 2015, 14(5):688-694.
[25]	He ZL, Zhou JB, Liu ZK, et al. Application of machine learning models for predicting acute kidney injury following donation after cardiac death liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2021, 20(3):222-231.
[26]	Trinh E, Alam A, Tchervenkov J, et al. Impact of acute kidney injury following liver transplantation on long-term outcomes[J]. Clin Transplant, 2017, 31(1).
[27]	Watt KD, Pedersen RA, Kremers WK, et al. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study[J]. Am J Transplant, 2010, 10(6):1420-1427.
[28]	Patel HK, Patel A, Abouljoud M, et al. Survival after liver transplantation in patients who develop renal insufficiency[J]. Transplant Proc, 2010, 42(10):4167-4170.
[29]	Campion D, Rizzi F. Assessment of glomerular filtration rate in patients with cirrhosis: available tools and perspectives[J]. Liver Int, 2022, 42(11):2360-2376.
[30]	Doi K, Nishida O, Shigematsu T, et al. The Japanese clinical practice guideline for acute kidney injury 2016[J]. Clin Exp Nephrol, 2018, 22(5):985-1045.
[31]	Rosi S, Piano S, Frigo AC, et al. New ICA criteria for the diagnosis of acute kidney injury in cirrhotic patients: can we use an imputed value of serum creatinine?[J]. Liver Int, 2015, 35(9):2108-2114.
[32]	Siew ED, Peterson JF, Eden SK, et al. Use of multiple imputation method to improve estimation of missing baseline serum creatinine in acute kidney injury research[J]. Clin J Am Soc Nephrol, 2013, 8(1):10-18.
[33]	Siew ED, Matheny ME, Ikizler TA, et al. Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury[J]. Kidney Int, 2010, 77(6):536-542.
[34]	Pickering JW, Endre ZH. Back-calculating baseline creatinine with MDRD misclassifies acute kidney injury in the intensive care unit[J]. Clin J Am Soc Nephrol, 2010, 5(7):1165-1173.
[35]	Markwardt D, Holdt L, Steib C, et al. Plasma cystatin C is a predictor of renal dysfunction, acute-on-chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis[J]. Hepatology, 2017, 66(4):1232-1241.
[36]	Asrani SK, Shankar N, da Graca B, et al. Role of novel kidney biomarkers in patients with cirrhosis and after liver transplantation[J]. Liver Transpl, 2022, 28(3):466-482.
[37]	Levitsky J, O'Leary JG, Asrani S, et al. Protecting the kidney in liver transplant recipients: practice-based recommendations from the American Society of Transplantation Liver and Intestine Community of Practice[J]. Am J Transplant, 2016, 16(9):2532-2544.
[38]	Ling Q, Xu X, Li J, et al. A new serum cystatin C-based equation for assessing glomerular filtration rate in liver transplantation[J]. Clin Chem Lab Med, 2008, 46(3):405-410.
[39]	Pottel H, Björk J, Rule AD, et al. Cystatin C-based equation to estimate GFR without the inclusion of race and sex[J]. N Engl J Med, 2023, 388(4):333-343.
[40]	Wu Z, Wang Y, He L, et al. Development of a nomogram for the prediction of acute kidney injury after liver transplantation: a model based on clinical parameters and postoperative cystatin C level[J]. Ann Med, 2023, 55(2):2259410.
[41]	Cholongitas E, Goulis I, Ioannidou M, et al. Urine albumin-to-creatinine ratio is associated with the severity of liver disease, renal function and survival in patients with decompensated cirrhosis[J]. Hepatol Int, 2017, 11(3):306-314.
[42]	Lima C, de Paiva Haddad LB, de Melo PDV, et al. Early detection of acute kidney injury in the perioperative period of liver transplant with neutrophil gelatinase-associated lipocalin[J]. BMC Nephrol, 2019, 20(1):367.
[43]	Yeung ACY, Morozov A, Robertson FP, et al. Neutrophil gelatinase-associated lipocalin (NGAL) in predicting acute kidney injury following orthotopic liver transplantation: a systematic review[J]. Int J Surg, 2018, 59:48-54.
[44]	Moledina DG, Isguven S, McArthur E, et al. Plasma monocyte chemotactic protein-1 is associated with acute kidney injury and death after cardiac operations[J]. Ann Thorac Surg, 2017, 104(2):613-620.
[45]	Zhang WR, Parikh CR. Biomarkers of acute and chronic kidney disease[J]. Annu Rev Physiol, 2019, 81:309-333.
[46]	Celec P, Vlková B, Lauková L, et al. Cell-free DNA: the role in pathophysiology and as a biomarker in kidney diseases[J]. Expert Rev Mol Med, 2018, 20:e1.
[47]	Alnazer I, Bourdon P, Urruty T, et al. Recent advances in medical image processing for the evaluation of chronic kidney disease[J]. Med Image Anal, 2021, 69:101960.
[48]	Hussaini T, Yoshida EM, Partovi N, et al. Early persistent progressive acute kidney injury and graft failure post liver transplantation[J]. Transplant Direct, 2019, 5(3):e429.
[49]	Durand F, Francoz C, Asrani SK, et al. Acute kidney injury after liver transplantation[J]. Transplantation, 2018, 102(10):1636-1649.
[50]	Tan HK, Marquez M, Wong F, et al. Pretransplant type 2 hepatorenal syndrome is associated with persistently impaired renal function after liver transplantation[J]. Transplantation, 2015, 99(7):1441-1446.
[51]	Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites[J]. Gut, 2015, 64(4):531-537.
[52]	Wong F, Pappas SC, Curry MP, et al. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome[J]. N Engl J Med, 2021, 384(9):818-828.
[53]	Piano S, Gambino C, Vettore E, et al. Response to terlipressin and albumin is associated with improved liver transplant outcomes in patients with hepatorenal syndrome[J]. Hepatology, 2021, 73(5):1909-1919.
[54]	Marengo A, Jouness RI, Bugianesi E. Progression and natural history of nonalcoholic fatty liver disease in adults[J]. Clin Liver Dis, 2016, 20(2):313-324.
[55]	Bansal S, Patel RN. Pathophysiology of contrast-induced acute kidney injury[J]. Interv Cardiol Clin, 2020, 9(3):293-298.
[56]	Facciorusso A. Hepatorenal syndrome type 1: current challenges and future prospects[J]. Ther Clin Risk Manag, 2019, 15:1383-1391.
[57]	Hiruy A, Nelson J, Zori A, et al. Standardized approach of albumin, midodrine and octreotide on hepatorenal syndrome treatment response rate[J]. Eur J Gastroenterol Hepatol, 2021, 33(1):102-106.
[58]	Nair G, Nair V. Simultaneous liver-kidney transplantation[J]. Clin Liver Dis, 2022, 26(2):313-322.
[59]	Pham PT, Lunsford KE, Bunnapradist S, et al. Simultaneous liver-kidney transplantation or liver transplantation alone for patients in need of liver transplantation with renal dysfunction[J]. Curr Opin Organ Transplant, 2016, 21(2):194-200.
[60]	Eason JD, Gonwa TA, Davis CL, et al. Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK)[J]. Am J Transplant, 2008, 8(11):2243-2251.
[61]	Tinti F, Mitterhofer AP, Umbro I, et al. Combined liver-kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry - a retrospective cohort study[J]. Transpl Int, 2019, 32(9):918-932.
[62]	Hmoud B, Kuo YF, Wiesner RH, et al. Outcomes of liver transplantation alone after listing for simultaneous kidney: comparison to simultaneous liver kidney transplantation[J]. Transplantation, 2015, 99(4):823-828.
[63]	宋继勇，杜国盛，许长涛, 等. 22例肝肾联合移植的经验分析[J].中华器官移植杂志, 2020, 41(11):672-676.
[64]	European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2):406-460.
[65]	Ekser B, Contreras AG, Andraus W, et al. Current status of combined liver-kidney transplantation[J]. Int J Surg, 2020, 82s:149-154.
[66]	Guo M, Gao Y, Wang L, et al. Early acute kidney injury associated with liver transplantation: a retrospective case-control study[J]. Med Sci Monit, 2020, 26:e923864.
[67]	Bredt LC, Peres LAB, Risso M, et al. Risk factors and prediction of acute kidney injury after liver transplantation: logistic regression and artificial neural network approaches[J]. World J Hepatol, 2022, 14(3):570-582.
[68]	Joosten A, Lucidi V, Ickx B, et al. Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study[J]. BMC Anesthesiol, 2021, 21(1):12.
[69]	Zhou J, Zhang X, Lyu L, et al. Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis[J]. BMC Nephrol, 2021, 22(1):149.
[70]	Hannon V, Kothari RP, Zhang L, et al. The association between vena cava implantation technique and acute kidney injury after liver transplantation[J]. Transplantation, 2020, 104(11):e308-e316.
[71]	中华医学会器官移植学分会. 肝肾联合移植技术操作规范(2019版) [J]. 器官移植, 2020, 11(1):30-40.
[72]	Sun K, Hong F, Wang Y, et al. Venovenous bypass is associated with a lower incidence of acute kidney injury after liver transplantation in patients with compromised pretransplant renal function[J]. Anesth Analg, 2017, 125(5):1463-1470.
[73]	Huang HB, Xu Y, Zhou H, et al. Intraoperative continuous renal replacement therapy during liver transplantation: a meta-analysis[J]. Liver Transpl, 2020, 26(8):1010-1018.
[74]	Agopian VG, Dhillon A, Baber J, et al. Liver transplantation in recipients receiving renal replacement therapy: outcomes analysis and the role of intraoperative hemodialysis[J]. Am J Transplant, 2014, 14(7):1638-1647.
[75]	Nashan B, Schemmer P, Braun F, et al. Evaluating the efficacy, safety and evolution of renal function with early initiation of everolimus-facilitated tacrolimus reduction in de novo liver transplant recipients: study protocol for a randomized controlled trial[J]. Trials, 2015, 16:118.
[76]	Sang BH, Bang JY, Song JG, et al. Hypoalbuminemia within two postoperative days is an independent risk factor for acute kidney injury following living donor liver transplantation: a propensity score analysis of 998 consecutive patients[J]. Crit Care Med, 2015, 43(12):2552-2561.
[77]	邓攀，赵于军，王强, 等. 肝移植术后并发急性肾损伤的诊疗进展[J/CD]. 中华移植杂志(电子版), 2020, 14(1):44-48.
[78]	Park MH, Shim HS, Kim WH, et al. Clinical risk scoring models for prediction of acute kidney injury after living donor liver transplantation: a retrospective observational study[J]. PLoS One, 2015, 10(8):e0136230.
[79]	Aksu Erdost H, Ozkardesler S, Ocmen E, et al. Acute renal injury evaluation after liver transplantation: with RIFLE criteria[J]. Transplant Proc, 2015, 47(5):1482-1487.
[80]	向丽，卢长江，吴胜东, 等. 肝移植术后急性肾损伤的研究进展 [J/CD]. 实用器官移植电子杂志, 2020, 8(2):137-141.
[81]	Wang YJ, Li JH, Guan Y, et al. Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients[J]. Hepatobiliary Pancreat Dis Int, 2021, 20(3):215-221.
[82]	翟慧敏，姜英俊，孔心涓, 等. 肾功能正常肝移植受者术后急性肾损伤风险预测模型的构建 [J/CD]. 实用器官移植电子杂志, 2022, 10(2):122-128.
[83]	陈佳弘，徐莹，何松哲, 等. 肝移植术后早期急性肾损伤的危险因素分析[J]. 中华器官移植杂志, 2023, 44(5):269-274.
[84]	Kalisvaart M, Schlegel A, Umbro I, et al. The impact of combined warm ischemia time on development of acute kidney injury in donation after circulatory death liver transplantation: stay within the golden hour[J]. Transplantation, 2018, 102(5):783-793.
[85]	Leithead JA, Tariciotti L, Gunson B, et al. Donation after cardiac death liver transplant recipients have an increased frequency of acute kidney injury[J]. Am J Transplant, 2012, 12(4):965-975.
[86]	Kim WH, Oh HW, Yang SM, et al. Intraoperative hemodynamic parameters and acute kidney injury after living donor liver transplantation[J]. Transplantation, 2019, 103(9):1877-1886.
[87]	Berkowitz RJ, Engoren MC, Mentz G, et al. Intraoperative risk factors of acute kidney injury after liver transplantation[J]. Liver Transpl, 2022, 28(7):1207-1223.
[88]	Caragata R, Emerson S, Santema ML, et al. Intraoperative hypotension and the risk of acute kidney injury following liver transplantation[J]. Clin Transplant, 2023, 37(10):e15053.
[89]	Khawar MB, Gao H, Li W. Autophagy and lipid metabolism[J]. Adv Exp Med Biol, 2019, 1206:359-374.
[90]	Kalisvaart M, Schlegel A, Umbro I, et al. The AKI prediction score: a new prediction model for acute kidney injury after liver transplantation[J]. HPB, 2019, 21(12):1707-1717.
[91]	Xu X, Ling Q, Wei Q, et al. An effective model for predicting acute kidney injury after liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2010, 9(3):259-263.
[92]	Lee HC, Yoon SB, Yang SM, et al. Prediction of acute kidney injury after liver transplantation: machine learning approaches vs. logistic regression model[J]. J Clin Med, 2018, 7(11):428.
[93]	Ren A, Li Z, Zhang X, et al. Optimal timing of initiating CRRT in patients with acute kidney injury after liver transplantation[J]. Ann Transl Med, 2020, 8(21):1361.
[94]	Ziolkowski J, Paczek L, Senatorski G, et al. Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity[J]. Transplant Proc, 2003, 35(6):2307-2309.
[95]	Lange NW, Salerno DM, Sammons CM, et al. Delayed calcineurin inhibitor introduction and renal outcomes in liver transplant recipients receiving basiliximab induction[J]. Clin Transplant, 2018, 32(12):e13415.
[96]	Buchholz BM, Ferguson JW, Schnitzbauer AA, et al. Randomized sirolimus-based early calcineurin inhibitor reduction in liver transplantation: impact on renal function[J]. Transplantation, 2020, 104(5):1003-1018.
[97]	谢琴芬，郑树森. 肝癌患者肝移植后的免疫抑制剂应用[J]. 中华器官移植杂志, 2013, 34(9):573-575.
[98]	Neuberger JM, Mamelok RD, Neuhaus P, et al. Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the 'ReSpECT' study[J]. Am J Transplant, 2009, 9(2):327-336.
[99]	Martin-Mateos RM, Graus J, Albillos A, et al. Initial immunosuppression with or without basiliximab: a comparative study[J]. Transplant Proc, 2012, 44(9):2570-2572.
[100]	Boyd A, Brown A, Patel J, et al. Basiliximab with delayed tacrolimus improves short-term renal outcomes post-liver transplantation-a real-world experience[J]. Transplant Proc, 2021, 53(5):1541-1547.
[101]	Teperman L, Moonka D, Sebastian A, et al. Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial[J]. Liver Transpl, 2013, 19(7):675-689.
[102]	Saliba F, Duvoux C, Gugenheim J, et al. Efficacy and safety of everolimus and mycophenolic acid with early tacrolimus withdrawal after liver transplantation: a multicenter randomized trial[J]. Am J Transplant, 2017, 17(7):1843-1852.
[103]	Vijayan A. Tackling AKI: prevention, timing of dialysis and follow-up[J]. Nat Rev Nephrol, 2021, 17(2):87-88.
[104]	Chopinet S, Bobot M, Reydellet L, et al. Peri-operative risk factors of chronic kidney disease after liver transplantation[J]. J Nephrol, 2022, 35(2):607-617.
[105]	Duan Y, Li Z, Wang X, et al. Risk factors and prognosis of new-onset chronic kidney disease following orthotopic liver transplantation: a retrospective case-control study[J]. Med Sci Monit, 2021, 27: e931834.
[106]	Guo D, Wang H, Liu J, et al. Prediction of chronic kidney disease after orthotopic liver transplantation: development and validation of a nomogram model[J]. BMC Nephrol, 2022, 23(1):33.
[107]	Jin H, Wei Y, Qian Y, et al. Renal histopathological lesions after liver transplantation: what can we find besides calcineurin inhibitor-induced nephrotoxicity?[J]. BMC Nephrol, 2022, 23(1):324.
[108]	Bhanji RA, Chow J, Ma M, et al. Post-liver transplantation chronic kidney disease is associated with increased cardiovascular disease risk and poor survival[J]. Transpl Int, 2021, 34(12):2824-2833.
[109]	Kalisvaart M, Schlegel A, Trivedi PJ, et al. Chronic kidney disease after liver transplantation: impact of extended criteria grafts[J]. Liver Transpl, 2019, 25(6):922-933.
[110]	Chan GS, Lam MF, Kwan L, et al. Clinicopathological study of renal biopsies after liver transplantation[J]. Hong Kong Med J, 2013, 19(1):27-32.
[111]	Lee JH, Cho YH, Ryu SJ, et al. Clinical usefulness of kidney biopsy in liver transplant recipients with renal impairment[J]. Kidney Res Clin Pract, 2013, 32(4):153-157.
[112]	Kim JY, Akalin E, Dikman S, et al. The variable pathology of kidney disease after liver transplantation[J]. Transplantation, 2010, 89(2):215-221.
[113]	中华医学会肾脏病学分会专家组. 中国慢性肾脏病患者高血压管理指南(2023年版)[J]. 中华肾脏病杂志, 2023, 39(1):48-80.
[114]	沈恬，庄莉，孙晓东, 等. 中国肝移植受者代谢病管理专家共识(2019版) [J/CD]. 中华移植杂志(电子版), 2019, 13(3):187-194.
[115]	Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease[J]. Adv Chronic Kidney Dis, 2006, 13(3):199-204.
[116]	Lee CY, Wu MY, Chan HC, et al. The influence of diabetes mellitus on the risks of end-stage kidney disease and mortality after liver transplantation[J]. Transpl Int, 2022, 35: 10023.
[117]	Tsai KF, Li LC, Hsu CN, et al. Effects of conversion from calcineurin inhibitors to sirolimus or everolimus on renal function and possible mechanisms in liver transplant recipients[J]. J Clin Pharmacol, 2019, 59(3):326-334.
[118]	Sapisochin G, Lee WC, Joo DJ, et al. Long-term effects of everolimus-facilitated tacrolimus reduction in living-donor liver transplant recipients with hepatocellular carcinoma[J]. Ann Transplant, 2022, 27: e937988.
[119]	Boudjema K, Camus C, Saliba F, et al. Reduced-dose tacrolimus with mycophenolate mofetil vs. standard-dose tacrolimus in liver transplantation: a randomized study[J]. Am J Transplant, 2011, 11(5):965-976.
[120]	Cederborg A, Noren A, Barten T, et al. Renal function after liver transplantation: real-world experience with basiliximab induction and delayed reduced-dose tacrolimus[J]. Dig Liver Dis, 2022, 54(8):1076-1083.
[121]	Tannuri U, Gibelli NE, Maksoud-Filho JG, et al. Mycophenolate mofetil promotes prolonged improvement of renal dysfunction after pediatric liver transplantation: experience of a single center[J]. Pediatr Transplant, 2007, 11(1):82-86.
[122]	Yang X, Yan H, Zhang X, et al. Comparison of renal safety and bone mineral density of tenofovir and entecavir in patients with chronic hepatitis B: a systematic review and meta-analysis[J]. Int J Infect Dis, 2022, 124:133-142.
[123]	Jung CY, Kim HW, Ahn SH, et al. Higher risk of kidney function decline with entecavir than tenofovir alafenamide in patients with chronic hepatitis B[J]. Liver Int, 2022, 42(5):1017-1026.
[124]	Cheng CH, Hung HC, Lee JC, et al. Converting from tenofovir disoproxil fumarate to tenofovir alafenamide in patients with hepatitis B following liver transplantation[J]. Ann Transplant, 2023, 28:e938731.
[125]	Liu JK, Vutien P, Huang DQ, et al. Renal outcomes with tenofovir alafenamide in liver transplant recipients[J]. Clin Gastroenterol Hepatol, 2023, 21(2):538-540, e534.
[126]	Yu LL, Shi XP, Huang JF, et al. A retrospective observational study of the treatment with polymyxin B for liver transplantation recipients infected by multidrug-resistant gram-negative bacteria[J]. J Clin Pharm Ther, 2022, 47(10):1563-1569.
[127]	Mostardeiro MM, Pereira CA, Marra AR, et al. Nephrotoxicity and efficacy assessment of polymyxin use in 92 transplant patients[J]. Antimicrob Agents Chemother, 2013, 57(3):1442-1446.
[128]	Panwar B, Johnson VA, Patel M, et al. Risk of vancomycin-induced nephrotoxicity in the population with chronic kidney disease[J]. Am J Med Sci, 2013, 345(5):396-399.
[129]	Yunhua T, Qiang Z, Lipeng J, et al. Liver transplant recipients with end-stage renal disease largely benefit from kidney transplantation[J]. Transplant Proc, 2018, 50(1):202-210.
[130]	上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J]. 中华肾脏病杂志, 2022, 38(5):453-464.
[131]	Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a review[J]. JAMA, 2019, 322(13):1294-1304.

项目	具体描述	研究类型
证据质量分级
高（A）	非常有把握：观察值接近真实值	RCT；质量升高二级的观察性研究
中（B）	对观察值有中等把握：观察值有可能接近真实值，但亦有可能差别很大	质量降低一级的RCT；质量升高一级的观察性研究
低（C）	对观察值的把握有限：观察值可能与真实值有较大差别	质量降低二级的RCT；观察性研究
极低（D）	对观察值几乎无把握：观察值与真实值可能有极大差别	质量降低三级的RCT；质量降低一级的观察性研究；系列病例观察；个案报道
推荐强度分级
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论质量高低的证据均显示利弊相当

项目	具体描述	研究类型
证据质量分级
高（A）	非常有把握：观察值接近真实值	RCT；质量升高二级的观察性研究
中（B）	对观察值有中等把握：观察值有可能接近真实值，但亦有可能差别很大	质量降低一级的RCT；质量升高一级的观察性研究
低（C）	对观察值的把握有限：观察值可能与真实值有较大差别	质量降低二级的RCT；观察性研究
极低（D）	对观察值几乎无把握：观察值与真实值可能有极大差别	质量降低三级的RCT；质量降低一级的观察性研究；系列病例观察；个案报道
推荐强度分级
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论质量高低的证据均显示利弊相当

分级	血清肌酐	尿量
1级	1.5～1.9倍基线值，或升高值≥26.5 μmol/L	连续6～12 h<0.5 ml·kg^-1·h^-1
2级	2.0～2.9倍基线值	连续12 h以上<0.5 ml·kg^-1·h^-1
3级	≥3.0倍基线值，或升高值≥353.6 μmol/L，或开始行肾脏替代治疗，或年龄<18岁者估算肾小球滤过率<35 ml·min^-1·（1.73 m²）^-1	连续24 h以上<0.3 ml·kg^-1·h^-1或无尿12 h

分级	血清肌酐	尿量
1级	1.5～1.9倍基线值，或升高值≥26.5 μmol/L	连续6～12 h<0.5 ml·kg^-1·h^-1
2级	2.0～2.9倍基线值	连续12 h以上<0.5 ml·kg^-1·h^-1
3级	≥3.0倍基线值，或升高值≥353.6 μmol/L，或开始行肾脏替代治疗，或年龄<18岁者估算肾小球滤过率<35 ml·min^-1·（1.73 m²）^-1	连续24 h以上<0.3 ml·kg^-1·h^-1或无尿12 h

GFR分期	GFR [ml·min^-1·（1.73 m²）^-1]	描述
G1期	≥90	正常或偏高
G2期	60～89	轻度下降^a
G3a期	45～59	轻-中度下降
G3b期	30～44	中-重度下降
G4期	15～29	重度下降
G5期	<15	肾衰竭

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