Symposium: Impaired renal function in advanced cirrhosis: diagnosis and management

 Cirrhosis and complications
 Webcasted session

West 1
15 April 2018 10:30 - 11:30

Since the implementation MELD score-based allocation policy in liver transplantation more than 10 years ago in Europe and the United States, attention focused on the management of patients with cirrhosis and organ failure(s), especially those with stage 2-3 acute kidney injury (AKI). Since serum creatinine is one of the three components of the MELD score, an increasing number of patients with cirrhosis and elevated serum creatinine are given priority for organ allocation. In addition, it must be noted that a syndrome characterized by cirrhosis complicated by rapidly progressing extrahepatic organ failure(s) with high early mortality, a syndrome now termed “acute-on-chronic liver failure” (ACLF), has been defined recently. In this context, stage 2-3 AKI in patients with cirrhosis now represents a challenging condition rather than an unavoidable terminal event. Even though candidates for transplantation and stage 2-3 AKI are given relatively high priority, mortality rates remain high, especially in those with ACLF. Not all patients are candidates for transplantation. However, management on the waiting list for transplantation represents a model for the management of end stage cirrhosis in general. Improving the management of these patients implies better understanding the mechanisms involved, identifying patients with a potential for renal recovery and patients without a potential for recovery and developing new biomarkers. New insights in the mechanisms represent potential targets for innovative therapeutic interventions. Finally, policies concerning the management of patients with advanced cirrhosis and stage 3 AKI remains very heterogeneous, including across highly specialized centers. While in some centers, aggressive management is systematically considered whatever patients are candidates for transplantation or not, there are still reluctance to initiate unrestricted intensive care with renal replacement therapy in other centers. Objective data need to be collected and summarized to reach a consensus. The objectives of this symposium are (i) to present updated data on the burden of impaired renal function in cirrhosis, (ii) to present new insights on the mechanisms involved, focusing on the complex interactions between cirrhosis, systemic circulatory changes, kidney circulatory changes and systemic inflammation, (iii) to present data concerning existing kidney biomarkers as well as novel biomarkers that may emerge in the near future and (iv) to discuss the place of aggressive management of stage 3 AKI in cirrhosis. 


Prevalence and prognostic implications of impaired renal function in cirrhosis: beyond definitions and classifications
Guadalupe Garcia-Tsao , United States
15 April 2018 10:30 - 10:45

New insights in the mechanisms: interactions between kidney circulatory changes, systemic circulatory changes, systemic inflammation and parenchymal kidney changes
Paolo Angeli , Italy
15 April 2018 10:45 - 11:00

Predicting renal recovery versus non recovery after liver transplantation: the role of kidney biomarkers
Claire Francoz , France
15 April 2018 11:00 - 11:15

Management of AKI in cirrhosis: place of terlipressin, hemofiltration and combined liver and kidney transplantation
Mitra Nadim , United States
15 April 2018 11:15 - 11:30