Abstract
      Renal failure is a challenging complication of cirrhosis and is one of the most important risk factors when liver transplantation is being considered. Patients with cirrhosis and renal failure are at high risk for death while awaiting transplantation and have an increased frequency of complications and reduced survival after transplantation, as compared with those without renal failure. In 2002, the Model for End-Stage Liver Disease (MELD) score — derived from measurements of serum bilirubin, the international normalized ratio of prothrombin time, and serum creatinine to evaluate pretransplantation renal function — was introduced as an aid to organ allocation among candidates for liver transplantation. Use of this scoring system has increased the number of patients with renal failure who receive a liver transplant and has reduced mortality among patients awaiting liver transplantation.
In recent years, substantial progress has been made toward understanding the pathogenesis and natural history of renal failure in cirrhosis. Moreover, newly identified clinical interventions may assist in the prevention and management of this complication.

Fulltext: http://content.nejm.org/cgi/content/full/361/13/1279