Renal Function in Sequential Living Kidney-Then-Liver Donors Undergoing Right Lobe Donation: A Two-Center Case Study

There are concerns regarding the potential impact of living donor hepatectomy on the kidney function of prior kidney donors. The current literature lacks comprehensive data on living liver following living kidney donation. Furthermore, the focus on left lobe donation in the literature does not fully represent the prevalent use of the right lobe graft for living liver transplants in the United States.

We performed a retrospective chart review on all living liver donors who had previously donated a kidney at two US centers.

There were 14 sequential living kidney-then-liver donors. The median donor age was 49 years (range 35-59). Most of these (12 donors) were nondirected donations. The median follow-up period was 24 months (range 1-129). The median interval between the donations was 32 months (range 17-154 months). All donors donated the right lobe with 43.5% (range 31.4%-49.9 %) of remnant liver volume. The overall donor complication rate was 43%, seen in six donors, with one Clavien-Dindo Grade IIIa complication (suture granuloma removal under local anesthesia). Two donors (14%) experienced stage 1 AKI, both resolving with supportive care. A decrease in eGFR greater than 10 mL/min/1.73 m² over the follow-up was observed in only one donor, who gained weight and was lost to follow-up. Compensatory kidney hypertrophy was observed, with kidney volumetry showing an increase of 1.27 (1.09-1.39) times pre- versus post-kidney donation and 1.08 times pre- versus post-liver donation (1.01-1.16).

Right lobe living liver donation in previous kidney donors might be safely performed in terms of midterm kidney function. Longer-term assessment in a larger cohort would be necessary to have better insight into this unique donor group.