Reply: Chronic kidney disease after liver transplantation: Accurate measurement, early acute kidney injury, and renal-protective strategies

Table 2 A staged agenda for renal preservation after liver transplantation

Domain	Prevailing practice	Proposed refinement	Principal supporting evidence
Measurement	Creatinine based estimation against a single threshold	Cystatin C based estimation, measured filtration for pivotal decisions, routine albuminuria	[5-8]
Perioperative care	Early standard dose calcineurin inhibitor	Haemodynamic optimisation, nephrotoxin avoidance, basiliximab enabled delay of calcineurin inhibitor in those at risk	[12,13]
Maintenance and monitoring	Static trough targeting	Mycophenolate enabled minimisation, surveillance by intrapatient variability and time in therapeutic range	[14,15,18,19]
Pharmacological protection	Confined to immunosuppression adjustment	Prospective evaluation of sodium glucose cotransporter 2 inhibitors and, where indicated, nonsteroidal mineralocorticoid receptor antagonists	[22-24]
Trial endpoints	Creatinine derived estimation	Measured filtration and validated injury biomarkers	[6,8]