Exploring the Viability of Matching Marginal Donors With Low Renal Function Recipients in Liver Transplantation.

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Abstract

BACKGROUND: Renal function varies among liver transplantation (LT) candidates with the same Model for End-Stage Liver Disease (MELD)3.0 score. The impact of marginal grafts on post-LT renal function and prognosis varies based on the pre-LT renal function. We explored the effects of matching recipients with low renal function to marginal donors on graft survival (GS) and post-LT kidney function.METHODS: We analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre-LT renal function by estimated glomerular filtration rate (eGFR) into low (<30mL/min/1.73m2) and high (=30mL/min/1.73m2). Marginal donors were defined by criteria including donation after cardiac death, age =65, severe macrosteatosis (=30%), or body mass index=40kg/m2. The primary outcome was to compare 3-year post-LT GS between patients with low and high pre-LT renal function. Additionally, we examined post-LT eGFR 1-3 months post-LT.RESULTS: Of 13279 LT recipients, 12851 had high pre-LT eGFR and 428 had low pre-LT eGFR. Kaplan-Meier survival analysis showed that recipients with low pre-LT eGFR had significantly lower 3-year GS compared to those with high eGFR (p<0.01). Recipients of organs from marginal donors also exhibited a significant reduction in 3-year GS (p<0.01). This adverse effect persisted within the same MELD3.0 category. Additionally, lower pre-LT eGFR was associated with an increased risk of post-LT kidney function deterioration, especially among those receiving grafts from marginal donors. Multivariable logistic regression identified recipient age>65 as a significant risk factor for post-LT kidney function decline (OR 3.34 [1.05-10.7]; p = 0.03).DISCUSSION: GS was notably worse in recipients with low pre-LT eGFR, particularly when matched with marginal donors. A recipient age>65 is a risk indicator for post-LT kidney function deterioration with marginal donors, underscoring the importance of careful donor-recipient matching, especially with compromised pre-LT kidney function.

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