Negative prognostic impact of renal replacement therapy in adult living-donor liver transplant recipients: preoperative recipient condition and donor factors.
BACKGROUND
In deceased-donor liver transplantation settings, post-transplantation acute renal failure with the induction of renal replacement therapy (RRT) is known to have negative effects on graft and patient survivals. However, the impact of RRT in living-donor liver transplantation (LDLT) has not been well investigated. The aim of this study was to elucidate risk factors requiring RRT and prognostic factors after its induction.


METHODS
Clinical data on the consecutive 113 adult patients who underwent LDLT from March 2002 to May 2013 were retrospectively reviewed. They were divided into 2 groups: RRT (n = 33) and Non-RRT (n = 80). The primary reasons for receiving RRT were hepatorenal syndrome (n = 17), sepsis (n = 12), and renal hypoperfusion (n = 4).


RESULTS
Although there were no significant differences in age or sex, the Model for End-Stage Liver Disease (MELD) score was significantly higher in the RRT group than in the Non-RRT group (23 ± 13 vs 16 ± 7; P = .002). The graft-recipient weight ratio (GRWR) was significantly lower in the RRT group (0.86 ± 0.3 vs 0.99 ± 0.2; P = .025). The 1- and 5-year patient survival rates were significantly higher in the Non-RRT group than in the RRT group (respectively, 91.3% and 84.3% vs 42.9% and 25.5%; P < .001). In multivariate analysis, independent risk factors for receiving RRT were MELD score >20 (P = .044) and GRWR <0.7 (P = .039). In the RRT group, donor age >50 years (P = .042) and preoperative serum creatinine level >1.5 mg/dL (P = .049) were significant prognostic risk factors.


CONCLUSIONS
In adult LDLT patients, the induction of RRT after LDLT was a negative predictor of survival. In addition to the preoperative recipient's condition, donor factors including graft size and donor age influenced prognosis after the induction of RRT.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
H
H
Iwata
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan. Electronic address: mizunos@clin.medic.mie-u.ac.jp.
S
S
Mizuno
Department of Cardiology and Nephrology, Mie University School of Medicine, Tsu, Mie, Japan.
E
E
Ishikawa
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
A
A
Tanemura
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Y
Y
Murata
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
N
N
Kuriyama
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Y
Y
Azumi
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Kishiwada
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Usui
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
H
H
Sakurai
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Tabata
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
N
N
Yamamoto
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
K
K
Sugimoto
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
K
K
Shiraki
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
Y
Y
Takei
Department of Cardiology and Nephrology, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Ito
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
S
S
Isaji
D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017582:Renal Replacement Therapy; D012307:Risk Factors; D015996:Survival Rate