Expert consensus on the clinical application of mammalian target of rapamycin inhibitors in liver transplant recipients with renal dysfunction in China (2025 edition)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANG Jiayin ,  XU Xiao ,  CHENG Ying

Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association; Branch of Organ Transplant Physicians of Chinese Medical Doctor Association;

Corresponding?author：

YANG Jiayin, Email: doctoryjy@scu.edu.cn; XU Xiao, Email: zjxu@zju.edu.cn; CHENG Ying, Email: chengying75@sina.com

Keywords：

liver transplantation; renal dysfunction; sirolimus; everolimus; mammalian target of rapamycin inhibitor

DOI：

10.7507/1007-9424.202509061

Video：

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Renal dysfunction is one of the common perioperative complications of liver transplantation, involving the preoperative, intraoperative, and postoperative stages. Its occurrence is closely associated with multiple factors, including underlying liver disease, intraoperative hemodynamic instability, ischemia-reperfusion injury, and immunosuppressive therapy. Renal injury not only affects recipients’ short-term outcomes, but may also lead to long-term deterioration of renal function, increase the risk of chronic kidney disease, and exert a sustained negative impact on quality of life. Although postoperative immunosuppressive therapy can effectively prevent rejection, long-term use—particularly of calcineurin inhibitors—may cause substantial nephrotoxicity. In recent years, strategies that use combination immunosuppressive regimens to reduce/minimize calcineurin inhibitors exposure and thereby preserve renal function have attracted increasing attention. Mammalian target of rapamycin inhibitors, which are commonly used immunosuppressants after liver transplantation, play an important role in preventing rejection, reducing tumor recurrence, and preserving renal function. This consensus aims to standardize the use and management of mammalian target of rapamycin inhibitors in the prevention and treatment of renal injury after liver transplantation, provide scientific, standardized, and rational guidance for the clinical application of immunosuppressive regimens, reduce the incidence of renal dysfunction, and help improve the quality of life of liver transplant recipients.

Citation： YANG Jiayin, XU Xiao, CHENG Ying. Expert consensus on the clinical application of mammalian target of rapamycin inhibitors in liver transplant recipients with renal dysfunction in China (2025 edition). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(2): 141-153. doi: 10.7507/1007-9424.202509061 Copy

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2. Pacheco MP, Carneiro-D’Albuquerque LA, Mazo DF. Current aspects of renal dysfunction after liver transplantation. World J Hepatol, 2022, 14(1): 45-61.
3. Cullaro G. Timing of acute kidney injury recovery a promising indicator of outcomes after liver transplantation. Transplantation, 2022, 106(4): 700-701.
4. Del Toro-Cisneros N, Antiga-López FJ, Felix-Bauer KC, et al. Development of a prediction index for persistent acute kidney injury following orthotopic liver transplant. Ann Hepatol, 2025, 30(2): 101923. doi: 10.1016/j.aohep.2025.101923.
5. Berkowitz RJ, Engoren MC, Mentz G, et al. Intraoperative risk factors of acute kidney injury after liver transplantation. Liver Transpl, 2022, 28(7): 1207-1223.
6. Nashan B, Schemmer P, Braun F, et al. Early everolimus-facilitated reduced tacrolimus in liver transplantation: results from the randomized HEPHAISTOS Trial. Liver Transpl, 2022, 28(6): 998-1010.
7. Watson CJ, Gimson AE, Alexander GJ, et al. A randomized controlled trial of late conversion from calcineurin inhibitor (CNI)-based to sirolimus-based immunosuppression in liver transplant recipients with impaired renal function. Liver Transpl, 2007, 13(12): 1694-1702.
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