*Purpose: Survival after living donor liver transplantation (LDLT) in the U.S. is excellent. However, the significance of pre-transplant kidney disease on outcomes after LDLT is poorly understood.

*Methods: This was a retrospective cohort study of 2,843 LDLT recipients nationally between 1/2010-6/2020. Baseline characteristics of recipients with estimated glomerular filtration rate <40mL/min/1.73m² (eGFR-low) or requiring dialysis were assessed. Multivariable survival analyses evaluated (i) eGFR-low as a predictor of post-LDLT survival, (ii) the survival of LDLT versus deceased donor liver transplant (DDLT) alone with eGFR-low.

*Results: From 2010-2020, 140 (5.0%) patients had eGFR-low and 18 (0.6%) required dialysis pre-LDLT. The number of LDLTs requiring dialysis between 2017-2020 outnumbered the prior 7 years (Figure – Panel A) and heterogeneity in center experience was observed (Panel B). Nearly half (5/12) of eGFR-low recipients with active kidney transplant listing at LDLT experienced renal recovery. Overall LDLT case volume was higher at centers performing LDLT in recipients with renal dysfunction (p<0.001). Accounting for baseline clinical differences, eGFR-low independently predicted post-LDLT mortality (adjusted HR 1.63; p=0.01). However, the adjusted survival of patients with eGFR-low receiving LDLT versus DDLT alone was not different (p=0.08). Of the 8 total deceased-donor KTs performed within the first year post-LDLT, 5 were facilitated by the new ‘safety-net’ KT policy.

*Conclusions: Overall, outcomes after LDLT with advanced renal dysfunction are acceptable. These findings are relevant given the recent ‘safety net’ kidney transplant policy.

« Back to 2021 American Transplant Congress