Acute kidney injury in donation after circulatory death liver transplantation: UK single centre study

Aim: to assess the incidence and classification of acute kidney injury (AKI) after liver transplantation (LT). Methods: this is a retrospective single-centre study of 1151 patients who underwent LT at the University Hospital Birmingham from 2007 to 2014. Exclusion criteria included: urgent (=66) and living donor (=7) transplantation. We considered: renal function pre-transplant and daily within one week post-transplant, characteristics of recipient, donor type (DCD vs.DBD), graft variables and indicators of initial graft function. AKI was defined and classified on the basis of KDIGO Guidelines (2012). Results: we considered 1078 LT patients (830 DBD and 248 DCD). DBD recipients had a significantly higher median MELD score (16.84 vs. 15.83, p=0.002) and serum bilirubin level (3.16 vs. 2.37, p<0.001) than DCD, whereas there were no differences in INR and serum creatinine values. Furthermore, DBD had significant longer cold and recipient warm ischemia times than DCD (p<0.001 and p=0.018 respectively). The incidence of AKI was 57.9% (624/1078 patients), of which 57.1% of DBD (474/830) vs. 60.5% of DCD (150/248). AKI classification is reported in the table. Conclusion: We demonstrate a higher incidence of post-LT stage 3 AKI in DCD, despite a better pre-LT liver function due to patient selection, compared to DBD. Compared to previous studies we note that both DBD and DCD recipients suffer a similar degree of stage 1-2 of AKI but the DCD experience more severe stage 3 AKI.