Background. Recipients of donation after circulatory death (DCD) grafts are reportedly at higher risk of developing post liver transplant (LT) renal dysfunction. Our aim was to compare development of acute kidney injury (AKI) and chronic kidney disease (CKD) after LT in recipients of DCD vs. neurological declared death (NDD) or living donor (LD) livers.

Methods. In this single-institution study, all adult cirrhotics who received single organ NDD, LD and DCD LT from 2012–2016 were included, with patients transplanted for polycystic disease or fulminant hepatic failure excluded. AKI was defined as post-transplant increase of serum creatinine (sCr) >26.5 [micro]mol/L in ≤48hrs or >50% increase from baseline, and CKD as eGFR ≤60 ml/min for ≥3 months.

Results. 716 patients (61 DCD, 474 NDD, 181 LD) with similar baseline co-morbidities were included. Patients in the LD group were significantly younger (p<0.001), together with a significantly lower MELD at transplant (16.4±6.7 vs. DCD:20.9±10; NDD:19.3±10; p<0.001). Peri-operative AKI occurred most frequently in the DCD group (57.4% vs. NDD:40.1% and LD:44.2%; p=0.032), likely related to higher sCr at the time of LT (142±103, vs. NDD: 125±120 vs. LD: 94±61[micro]mol/L; p=0.001) and associated with significantly higher peak AST levels (3157±3355 vs. NDD:1670±2495 vs. LD:705±799IU/L; p<0.001). Despite a significantly higher peak sCr in the DCD group (181±96 vs. NDD:161±120 vs. LD:128±81[micro]mol/L; p=0.001), all 3 groups had similar AKI recovery rates, and similar proportions evolving into CKD (27% vs. 31% vs. 32%, p=0.809). However, patients in need for perioperative and immediate post-transplant renal replacement therapy (RRT) showed significantly lower patient survival in multivariate analysis: (p=0.006 (HR: 3.225, 95%CI 1.402-7.422)).

Conclusion. Recipients of DCD liver grafts have higher post-transplant renal dysfunction compared to NDD or LD, without affecting long-term renal function. However, recipients with perioperative RRT have lower patient survival. Efforts to reduce AKI in the perioperative period may decrease development of CKD and improve patient long-term outcomes.

CITATION INFORMATION: Kollmann D., Neong S., Rosales R., Sapisochin G., Bhat M., Cattral M., Greig P., Lilly L., McGilvray D., Ghanekar A., Grant D., Selzner M., Wong F., Selzner N. Transplantation of DCD Livers vs. NDD and LDLT: Is There a Difference in Post-Transplant Kidney Dysfunction? Am J Transplant. 2017;17 (suppl 3).

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