A comparison of rates and severity of chronic kidney disease in deceased-donor and living-donor liver transplant recipients: times matter

Yücel Yankol,Nesimi Meci̇t,Joshua D Mezrich,David Foley,Glen E Leverson,Turan Kanmaz,Michael Rizzari,Emily Bugeaud,Tiffany Zens,Anthony M D’Alessandro,Münci Kalayoğlu,Oya M Andaçoğlu,Koray S Acarli,Luis A Fernandez

doi:10.3906/sag-2007-82

Abstract

Background/aim The progression of chronic kidney disease (CKD) in recipients of living-donor liver transplant (LDLT) compared to deceased-donor liver transplant (DDLT) has not been studied in the literature. We hypothesize that CKD stage progression in LDLT recipients is reduced compared to that of their DDLT counterparts. Materials and methods A retrospective study was undertaken including 999 adult, single-organ, primary liver transplant recipients (218 LDLT and 781 DDLT) at 2 centers between January 2003 and December 2012, in which CKD progression and regression were evaluated within the first 3 years after transplantation. Results Waiting time from evaluation to transplantation was significantly lower in LDLT patients compared to recipients of DDLT. CKD stage progression from preoperative transplant evaluation to transplantation was significantly greater in DDLT. Deceased-donor liver transplant recipients continued to have higher rates of clinically significant renal disease progression (from stage I–II to stage III–V) across multiple time points over the first 3 years posttransplant. Furthermore, a greater degree of CKD regression was observed in recipients of LDLT.Conclusion It can be concluded that LDLT provides excellent graft and patient survival, significantly reducing the overall incidence of clinically significant CKD stage progression when compared to DDLT. Moreover, there is a significantly higher incidence of CKD stage regression in LDLT compared to DDLT. These observations were maintained in both high and low model for end-stage liver disease(MELD)populations. This observation likely reflects earlier access to transplantation in LDLT as one of the contributing factors to preventing CKD progression.

Highlights

It can be concluded that living-donor liver transplants (LDLT) provides excellent graft and patient survival, significantly reducing the overall incidence of clinically significant chronic kidney disease (CKD) stage progression when compared to deceased-donor liver transplants (DDLT)
There is a significantly higher incidence of CKD stage regression in LDLT compared to DDLT
During the past few decades, outcomes of liver transplantation (LT) have dramatically improved, but many patients still die on waiting lists (WL) due to the current shortage of suitable organs [1].One strategy used to counter balance the organ shortage has been the utilization of living-donor liver transplants (LDLT)

Summary

Introduction

During the past few decades, outcomes of liver transplantation (LT) have dramatically improved, but many patients still die on waiting lists (WL) due to the current shortage of suitable organs [1].One strategy used to counter balance the organ shortage has been the utilization of living-donor liver transplants (LDLT). The transplant community turns its attention to the long‐term complications associated with transplant and immunosuppression, such as chronic medical conditions, opportunistic infections, and malignancy, in order to optimize patients’ quality of life after transplant. Both preoperative and postoperative chronic kidney disease (CKD) and end‐stage renal disease (ESRD) are common problems following LT and carry significant morbidity and mortality [5,6,7,8].

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Discussion

Conclusion