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Transplantation
PTU-057 Split liver transplant recipients are less likely to require peri-operative renal replacement therapy than full-size liver transplant controls
  1. J A Leithead1,2,
  2. M J Armstrong1,2,
  3. C Corbett1,2,
  4. M Andrew1,
  5. C Kothari1,
  6. F Tinti1,
  7. B K Gunson2,
  8. D Mirza1,
  9. P Muiesan1,
  10. J W Ferguson1
  1. 1Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
  2. 2NIHR Biomedical Research Unit and Centre for Research, University of Birmingham, Birmingham, UK

Abstract

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).

Abstract PTU-057 Table 1

Post transplant renal outcomes in SLT recipients and FSLT controls

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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