The impact of renal replacement therapy before or after living donor liver transplantation

Introduction: The impact of renal replacement therapy (RRT) in living donor liver transplantation (LDLT) has not yet been investigated. Methods: Among 253 LDLT patients, RRT was started before (RRT-Pre, n=9), or after (RRT-Post, n=27) LDLT. The clinical outcomes were reviewed. Results: The one-yr graft survival rate was 94.1% without RRT, and 63.9% and in those with RRT (p<0.0001). Among the RRT patients, the RRT-Pre patients exhibited acute liver failure, hepatorenal syndrome and high model for end-stage liver disease score (35±12), whereas the RRT-Post patients had sepsis as a comorbidity. The one-yr graft survival rate was 100.0% in the RRT-Pre patients vs. 51.9% in the RRT-Post patients (p<0.01). The duration of RRT was significantly shorter in the RRT-Pre patients than that in the RRT-Post patients (5.3±2.1 vs. 17.8±14.1d, p=0.02). The mean duration between starting RRT and LDLT was 2.1±0.7d in the Pre-RRT patients. Conclusion: The RRT-Pre patients had excellent outcomes because the severe condition was primarily treated by LDLT after short-term pre-transplant RRT. Post-transplant uncontrollable sepsis was the major cause of graft loss in patients who receive RRT after LDLT.