With the ongoing organ shortage, there has been an increased interest in using moderately steatotic liver allografts. The impact of such allografts on recipients' post-liver transplant (LT) kidney function remains poorly studied. In order to investigate this in detail, we examined the correlation of moderate allograft steatosis and post-transplant acute kidney injury (AKI) in a large cohort of LT recipients with protocol biopsies.

Methods: 786 LT recipients from January 2009 to December 2016 were identified, and their data collected. All allografts were biopsied before implantation, and the degree of steatosis (macro-, micro- or both) was assessed by designated liver pathologists at our institution. Moderate steatosis was defined as macrosteatosis of 30-60%. Acute kidney injury (AKI) was defined per the KDIGO criteria. LT recipients with pre-LT AKI were excluded. Chi-square and unequal variance t-test were used to compare variables, and Kaplan Meier plots for survival.

Results: Mean macrovesicular steatosis in post-LT non-AKI and AKI patients was 5.8±7.1% and 44.3±14.84% (p<0.0001). There were no differences in recipient age (p=0.69), sex (p=0.49), primary liver disease (p=0.62) or biologic MELD (p=0.38) between the groups. Recipients of moderately macrovesicular grafts had a significantly higher incidence of post-LT AKI compared to those receiving grafts with <30% steatosis (53.3% vs. 18.1%) (p<0.001). Need for post-LT dialysis was higher in patients with moderately steatotic grafts (13.3% vs. 1.3%) (p=0.009). There were no differences in 1-year graft (96.7% vs. 97.2%, p=0.81) or patient survival (96.7% vs. 97.9%, p=0.68). Similarly, there were no differences in long-term renal recovery between steatotic and non-steatotic groups: complete resolution (75.0% vs. 76.9%) and progression to non-dialysis chronic kidney disease (12.5% vs. 23.1%) (p=0.33). While the degree of microsteatosis by itself was not associated with an increased incidence of AKI (23.5% vs. 25.0%) (p>0.99), it appeared to increase this risk when present along with moderate macrosteatosis (43.2% vs. 16.9%, p<0.001). Older recipients of moderately steatotic grafts demonstrated a propensity to develop AKI (p=0.066).

Conclusions: Recipients of liver allografts with moderate macrovesicular steatosis have an increased risk of post-LT AKI. Although long-term outcomes appear similar, the data suggests that caution must be used when utilizing these allografts in recipients with underlying kidney disease.

CITATION INFORMATION: Jadlowiec C., Mao S., Abdelwahab D., Nehra A., Taner T. Influence of Liver Allograft Steatosis on Postoperative Acute Kidney Injury Am J Transplant. 2017;17 (suppl 3).

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