The impact of renal replacement therapy before or after living donor liver transplantation

The impact of renal replacement therapy (RRT) in living donor liver transplantation (LDLT) has not yet been investigated.

Among 253 LDLT patients, RRT was started before (RRT-Pre, n = 9), or after (RRT-Post, n = 27) LDLT. The clinical outcomes were reviewed.

The one-yr graft survival rate was 94.1% without RRT, and 63.9% and in those with RRT (p < 0.0001). Among the RRT patients, the RRT-Pre patients exhibited acute liver failure, hepatorenal syndrome and high model for end-stage liver disease score (35 ± 12), whereas the RRT-Post patients had sepsis as a comorbidity. The one-yr graft survival rate was 100.0% in the RRT-Pre patients vs. 51.9% in the RRT-Post patients (p < 0.01). The duration of RRT was significantly shorter in the RRT-Pre patients than that in the RRT-Post patients (5.3 ± 2.1 vs. 17.8 ± 14.1 d, p = 0.02). The mean duration between starting RRT and LDLT was 2.1 ± 0.7 d in the Pre-RRT patients.

The RRT-Pre patients had excellent outcomes because the severe condition was primarily treated by LDLT after short-term pre-transplant RRT. Post-transplant uncontrollable sepsis was the major cause of graft loss in patients who receive RRT after LDLT.