Chronic Kidney Disease Stage Progression Comparing Living Donor and Deceased Donor Liver Transplant Recipients.

Abstract

Background It is unknown how the progression of chronic kidney disease (CKD) compares in recipients of living donor (LD) vs deceased donor (DD) liver transplants. We hypothesize that access to living donation expedites transplant, eliminating the waiting period that deceased donors incur. Consequently, CKD stage progression will be reduced. Materials and Methods We performed a retrospective review of 958 adult LD (n=218) and DD (n=740), single-organ primary liver transplants from Jan 2003 and Dec 2012 among two institutions and analyzed CKD progression. Patients beyond Milan criteria and neuroendocrine tumors were excluded. Immunosupression and anti-viral therapy was consistent among all groups. The primary end point was the incidence of CKD progression of at least one stage from evaluation to transplant and at least two stage CKD progression at 1, 3 and 5 years post-transplant. Results Demographics were comparable between LD and DD with the exception of MELD scores (16 vs 23) and GFR at time of evaluation (109 vs 72 mg/dl, p<0.01). The time from evaluation to transplant was significantly lower in LD vs DD (65 vs 398 days, p<0.01). Kaplan-Meier estimates of 5 year graft and patient survival were similar in the LD (80%, 90%) and DD (75%, 81%) (p=0.72 and 0.13, respectively). CKD progression of at least one stage from the time between evaluation to transplant was lower in the LD when compared to DD group (12% vs 34%, p=<0.01). Although, the incidence of at least one stage CKD progression after transplantion was higher in LD when compared to DD transplant (1yr: 57% vs 28%; 3yr: 61% vs 31%; and 5yr: 60% vs 31%), the progression from the time of evaluation to CKD stage three or greater after transplant remained overall lower in LD vs DD (1yr: 25%* vs 31%; 3yr: 20% vs 34%; and 5yr: 15% vs 34%). Conclusions Living donor liver transplantation provides excellent graft and patient survival, reducing significantly the overall incidence clinically significant CKD stage progression when compared to deceased donors. This observation likely reflects earlier access to transplantation in living donor liver transplant recipients rather than quality of the organs at transplantation between LD vs DD.