Impact of pre-transplant renal dysfunction on 6-month graft failure in living versus deceased donor liver transplantation: Retrospective propensity score-matched study

Introduction: We compared the effect of pre-liver transplantation (LT) renal dysfunction on mid-term post-transplant outcomes in LDLT versus DDLT. Methods: A total of 2133 adult patients who underwent LT between May 1996 and December 2021 were analyzed, with 445 patients selected in each group after propensity score matching. The primary outcome measured was the incidence of 6-month graft failure. Results: In the LDLT group, 64 % of recipients had no pre-LT renal dysfunction, while 36 % did (GroupL and GroupLR). In the DDLT group, 60 % of recipients had no pre-LT renal dysfunction, while 40 % did (GroupD and GroupDR). The patients with pre-LT renal dysfunction experienced a significantly higher rate of 6-month graft failure in both groups (L vs. LR, p = 0.002, and D vs. DR, p = 0.016). However, there was no significant difference in 6-month graft failure risk between LDLT with pre-LT renal dysfunction and DDLT, with or without pre-LT renal dysfunction. Conclusions: Renal dysfunction prior to LT has a negative impact on mid-term outcomes. Interestingly, LDLT recipients with pre-LT renal dysfunction did not show superior graft survival compared to DDLT recipients, irrespective of their renal function status. Thus, our study emphasizes the importance to consider renal function at the time of LT.