Split liver transplant recipients do not have an increased frequency of acute kidney injury

Abstract

Small series have suggested that split liver transplantation (SLT) has an increased frequency of peri-operative acute kidney injury (AKI). However, the optimal donor selection in this setting could have a favourable impact on renal outcomes. This was a retrospective single-centre study of 76 adults who underwent SLT (right extended lobe) and 301 adults who underwent elective full-size donation after brain death liver transplantation (FSLT). SLT recipients were less likely than unmatched FSLT recipients to develop AKI (≥stage 1 KDIGO criteria) (40.3% vs. 56.1%, P = 0.016) and had a reduced frequency of renal replacement therapy (11.8% vs. 21.9%, P = 0.049). In 72 pairs of SLT patients and propensity risk score-matched FSLT controls the incidence of AKI was not significantly different (40.3% vs. 47.2%, P = 0.473). However, SLT patients were less likely to require renal replacement therapy (11.1% vs. 23.6%, P = 0.078; adjusted OR 0.32; 95% CI 0.11-0.87, P = 0.026). There was no association between SLT and the development of chronic kidney disease (eGFR<60 ml/min/1.73 m(2) , log rank P = 0.534). In conclusion, SLT is not associated with an increased frequency of AKI. These observations support the postulation that the optimal donor status of SLT may result in less graft injury with renal sparing effects.

Right lobe split liver transplantation versus whole liver transplantation in adult recipients: A systematic review and meta‐analysis

“…After independent reviews, 34 full‐text articles were excluded for the following reasons: (1) 10 studies did not have WLT recipients as a control group; (2) 4 studies involved too many children but lacked a separate analysis for adult recipients; (3) 9 studies lacked available data of outcomes of interest; (4) 1 study excluded patients who died in the perioperative period; (5) 7 studies lacked a separate analysis of right lobe SLT recipients or did not clearly describe the splitting graft types; and (6) 3 studies investigating the comparison of outcomes between full‐right‐full‐left SLT and WLT. Finally, 17 clinical studies were included in the meta‐analysis, all of which were performed on the basis of retrospective cohorts …”

Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations

“…There is conflicting evidence whether the presence of mitral or tricuspid regurgitation affects transplant outcomes. 118,119 One of the hypotheses for this discrepancy is the inability to precisely estimate pulmonary arterial systolic pressure with TTE.…”

“…Among these patients, intraoperative cardiac output is often increased and systemic vascular resistance significantly decreased with associated increases in intraoperative hypotension requiring vasopressor support 117. There is conflicting evidence whether the presence of mitral or tricuspid regurgitation affects transplant outcomes 118,119. One of the hypotheses for this discrepancy is the inability to precisely estimate pulmonary arterial systolic pressure with TTE.Aortic stenosis (AS) causes pressure overload and hypertrophy of the LV, as well as decreased LV compliance.…”

Considering extended right lobe grafts as major extended donor criteria in liver transplantation is justified

“…1). Only studies that clearly described the splitting techniques, evaluated outcome of ERL liver grafts compared with WL grafts, and did not analyze overlapping collectives were eligible for analysis of ERLT and WLT outcomes [6,15,18,19,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Despite the high quality, the study of Adam et al did not provide precise definition of the splitting liver technique and their study was therefore excluded from the analysis [46].…”