Korean J Transplant.  2022 Nov;36(Supple 1):S52. 10.4285/ATW2022.F-1705.

Living donor liver transplantation alone is not inferior to combined kidney liver transplant for the cirrhotic patients with chronic kidney disease

• Das LK
• Verma S
• Naganathan SK
• Agarwal S
• Varma V
• Dey R
• Gupta S

• KMID: 2535256
• DOI: http://doi.org/10.4285/ATW2022.F-1705

Abstract

Background
Chronic kidney disease (CKD) is common in patients with chronic liver disease (CLD) and so is acute kidney injury (AKI). The differentiation of CKD versus AKI is often difficult and sometimes both may coexist. A combined kidney liver transplant (CKLT) may result in kidney transplant in patients whose renal function is likely to recover or at least have stable renal function posttransplant. This audit was carried out on liver transplant recipients with CKD 3–5 who underwent either liver transplant alone (LTA) or CKLT. We aim to look at outcomes and long-term evolution of renal function in those who underwent LTA so that recommendations can be made for patients with CKD.
Methods
We retrospectively enrolled 2,742 patients who underwent LDLT at our center from 2006–2019. Among them, 47 pa-tients met the medical eligibility criteria for CKLT. Twenty-five of 47 underwent LTA and the rest 22 underwent CKLT in our co-hort. The diagnosis of CKD was made according to the KDIGO classification.
Results
Subgroup analysis was done in both groups based on the history of dialysis. Preoperative creatinine was similar be-tween two groups (P=0.63) whereas the glomerular filtration rate (GFR) was significantly lower in the CKLT group (P=0.007). Among survival of LTA patients, eight (57%) patients had a stable renal function at 1 month and 1 year posttransplant, two (14%) renal function recovered completely, two (14%) were under regular hemodialysis and two (14%) died of COVID-19 infection. Pa-tient survival was significantly better in CKD stage 5 patients who underwent CLKT (log-rank, P =0.0009) whereas survival was better in the LTA group in CKD stage 3 (P=0.03).
Conclusions
This study shows that LTA or sequential kidney is not inferior to CLKT in living donor situations except for CKD stage 5. Renal dysfunction is stabilized while long-term dialysis may be carried out in others.