Severity of postoperative acute kidney injury predicts development of chronic kidney disease after DCD liver transplantation

M. Kalisvaart, A. Schlegel, I. Umbro, J.E. de Haan, I. Scalera, W.G. Polak, J.N.M. IJzermans, D.F.M. Mirza, M.T.P.R. Perera, J. Isaac, A.P. Mitterhofer, P. Muiesan, J. de Jonge

Friday 16 march 2018

15:00 - 15:10h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 18: Clinical

Background

About 50% of the patients who receive a donation after circulatory death (DCD) graft develop acute kidney injury (AKI) after liver transplantation. However, the incidence and aetiology of chronic kidney disease (CKD) with the use of these high risk grafts remains less well defined. Our aim was to analyse the development of CKD in relation with postoperative AKI after DCD liver transplantation.

Methods

Two-center retrospective cohort study of all DCD liver transplantations (2001-2015). eGFR was calculated using the MDRD-4 formula and kidney function was divided into 3 groups: no CKD (eGFR ≥60), mild CKD (eGFR 30-59) and severe CKD (eGFR <30). Recipients who died or underwent retransplantation in the first 3 months after transplant were excluded. Postoperative AKI was defined according to KDIGO criteria.

Results

A total of 381 patients were included. The median pre-transplant eGFR was 100 (IQR 77-123) ml/min/1.73m². 61% of the recipients had acute kidney dysfunction in the first week after transplantation, but in most of these recipients (59%) kidney function recovered in the first month. Afterwards, a slow decrease in kidney function was observed. Overall, 153 (40%) recipients developed CKD, but only 17 (5%) developed severe CKD. Four recipients required long-term renal replacement therapy (RRT) and 1 recipient underwent kidney transplantation. Multivariable cox-regression identified severity of AKI as an independent risk factor for the development of CKD: hazard ratio 1.51 (95% CI 1.01-2.28) for patients with AKI without RRT and hazard ratio 2.0 (95% CI 1.29-3.20) for recipients with AKI requiring RRT. Other independent predictors were recipient age, pre-transplant kidney function and female gender.

Conclusion

The majority of early kidney dysfunction after DCD liver transplantation resolves in the first months and the incidence of severe CKD after DCD liver transplantation is relatively low. However, the severity of postoperative AKI is an independent predictor of chronic renal impairment.