Introduction Several small studies have suggested that split liver transplant (SLT) recipients have an increased frequency of peri-operative acute kidney injury (AKI). However, given that hepatic ischaemia-reperfusion injury may play a role in the pathogenesis of peri-transplant AKI, the optimal donor selection of split liver transplantation could have a favourable impact on renal outcomes. Our aim was to compare renal outcomes in SLT recipients with matched full-size liver transplant (FSLT) controls.
Methods Single-centre study of 72 patients who received a SLT for chronic liver disease 01/2007–06/2011. 72 FSLT (Donation after Brain Death) controls were matched by propensity-risk-score. Definitions: AKI, peak creatinine ≥2 times baseline; chronic kidney disease (CKD), MDRD4 eGFR <60 ml/min/1.73 m2.
Results SLT recipients and FSLT controls were well matched on confounders. Split liver grafts had a younger donor age (p<0.001), longer cold ischaemic time (p=0.026) but similar warm ischaemic time (p=0.213). There was no difference in the intra-operative red cell concentrate requirements between the groups (p=0.460). During the immediate post-operative period, the median peak AST was 1156 U/L for SLT recipients and 1124 U/L for FSLT controls (p=0.960). The frequency of re-laparotomy for bleeding (p=0.310), primary non-function (p=1.000), sepsis (p=0.643) and biliary complications were comparable (p=1.000). Estimated 3-year patient survival was 90.0% and 91.8% for SLT recipients and controls, respectively (log-rank p=0.400). Peri-operative and long-term renal outcomes are outlined in Abstract PTU-057 table 1. There was no difference between the two groups, with the exception of renal replacement therapy; SLT recipients were less likely to require peri-operative renal replacement therapy than FSLT controls (p=0.048).
Conclusion SLT recipients are less likely to require peri-operative renal replacement therapy than well matched FSLT recipients. Higher graft quality and/or smaller graft volume may have a beneficial renal-sparing effect.
Competing interests None declared.
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