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.
