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

Authors: YÜCEL YANKOL, EMILY BUGEAUD, TIFFANY ZENS, MICHAEL RIZZARI, NESİMİ MECİT, GLEN E. LEVERSON, DAVID FOLEY, JOSHUA D. MEZRICH, TURAN KANMAZ, OYA MÜNEVVER ANDAÇOĞLU, ANTHONY M. D'ALESSANDRO, KORAY SADIK ACARLI, MÜNCİ KALAYOĞLU, LUIS A. FERNANDEZ

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.

Keywords: Living-donor liver transplantation, deceased-donor liver transplantation, chronic kidney disease, outcomes, mortality, graft survival

Full Text: PDF