Surgical factors and not donor type per se are risk factors for acute kidney injury after liver transplantation

Background: Because Liver Transplantation (LT) using DCD has been shown to be risk factor for Acute Kidney Injury (AKI), we reviewed results at our center.
Patients and Methods: AKI was defined as decrease >50% eGFR (CKD- EPI) within 48 h postreperfusion (RIFLE). 106 first LT-only [63 DBD (59%) & 43 DCD (41%)] without pre-existing renal dysfunction (eGFR>60 ml/min/1,73 m2, no renal replacement therapy) were performed from 2012 to 2016. Incidence/ risk factors for AKI were assessed. Data: mean (IQR).
Results: Incidence of AKI was 33% (35/106). AKI-patients were more hospitalized before LT [9/16 (56%) vs 26/89 (29%), p < 0.01], with higher labMELD [16 (10–23) vs 12 (8–16), p = 0.01]. Donor type [11/43 DCD (25%) vs 24/63 DBD (39%), p = 0.16], donor hepatectomy time [38 min (26–50) vs 35 (25–42), p = 0.37], cold ischemic time [6 h (4.1–7.6) vs 5.1 (3.4–6.4), p = 0.21], time for anastomosis [44 min (35–49) vs 42 (38–48), p = 0.53], postreperfusion syndrome [19/46 (42%) vs 27/46 (58%), p = 0.07] were similar between AKI & non-AKI groups. AKI was more frequent if lungs were procured first in the donor [23/48 (48%) vs 11/56 (19%), p < 0.01]. Recipient surgery was longer in the AKI group [5.2 h (3.9–6.3) vs 4.3 (3.4–4.8), p < 0.01]. AKI was more frequent if platelets were transfused during LT [19/42 (56%) vs 15/59 (44%), p = 0.03]. Blood volume administrated from the cellsaver was larger in the AKI-patients [834 ml (300–750) vs 408 (0–550), p = 0.03]. AKI-patients have a higher peak AST [1235 U/L (310–1858) vs 812 (429–978), p = 0.04]. Haemoglobin [8.8 g/dl (7.4–9.9) vs 10 (8.5–11.7)] & platelets [69x103 (50 9 103–87 9 103) vs 89 9 103 (50 9 103–118 9 103)] at day 1 postreperfusion were significantly lower if AKI occurred. After multivariable analysis, thoracic procurement before liver [OR 5.75 (1.76–18.77), p = 0.004] & recipient surgery duration [OR 1.64 (1.15–2.32), p = 0.006] were only risk factors for AKI.
Conclusion: Rapid donor/recipient surgery and not donor type are key factors to prevent AKI-post-LT.