Renal Dysfunction After Liver Transplantation: Effect of Donor Type

Area of Science:

• Nephrology
• Hepatology
• Transplantation Medicine

Background:

• Donation after circulatory death (DCD) liver grafts are associated with increased risk of renal dysfunction post-liver transplantation (LT).
• Understanding the incidence and outcomes of kidney injury in recipients of DCD versus other donor types is crucial for patient management.

Purpose of the Study:

• To compare the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) in liver transplant recipients receiving grafts from DCD, donation after brain death (DBD), or living donors (LDLT).

Main Methods:

• Retrospective cohort study of adult liver transplant recipients at Toronto General Hospital between 2012 and 2016.
• Patients received grafts from DCD (n=57), DBD (n=446), or LDLT (n=178) donors.
• AKI defined by serum creatinine increase; CKD defined by estimated glomerular filtration rate <60 mL/minute for >3 months.

Main Results:

• Perioperative AKI occurred more frequently in the DCD group (61%) compared to DBD (40%) and LDLT (44%) (P=0.01).
• DCD recipients showed higher peak serum creatinine and a trend towards higher rates of AKI stage 3.
• Proportions of AKI recovery and development of CKD were similar across all groups. Patients requiring renal replacement therapy had significantly lower survival.

Conclusions:

• Liver transplant recipients receiving DCD grafts experience higher rates of short-term renal dysfunction compared to DBD or LDLT grafts.
• Avoiding risk factors like high MELD score, massive transfusions, and advanced donor age may mitigate severe kidney injury.
• While short-term renal dysfunction is more common with DCD grafts, long-term CKD incidence and AKI recovery rates are comparable across donor types.