Do you routinely use markers or tests other than serum creatinine when estimating GFR to determine if patients with liver failure, not on dialysis, meet criteria for a simultaneous liver-kidney transplant?

This is a good question as eGFR cutoffs of 25ml/min (AKI) and 30ml/min (CKD) are used as criteria for SLK eligibility and yet the accuracy of the creatinine-based equations is known to be sub-optimal in patients with liver cirrhosis. UNOS does not specify the type of equation that should be used.

In general, Cr based equations will under-estimate true GFR in ESLD. Cystatin C-based equations are potentially of help but may underestimate true GFR and tilt the bias the other way.

At my institution cy...

Over the past year, the use of Cystatin C has been incorporated frequently to assess renal function. This can be particularly helpful due to the muscle wasting associated with liver failure and its inherent catabolic state, making creatinine inaccurate. There is nothing in UNOS/OPTN policy that dictates the method of assessment to determine renal function.

Yes, absolutely. Our program routinely uses cystatin C-based eGFR to determine eligibility for SLK.