Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Artículo Open Access |
| Published: |
Wiley
2025
|
| Subjects: | |
| Online Access: | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70123 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Table of Contents:
- Exploring the Viability of Matching Marginal Donors With Low Renal Function Recipients in Liver Transplantation Miho Akabane Yuki Imaoka Toshihiro Nakayama Carlos O. Esquivel Kazunari Sasaki Clinical Transplantation ABSTRACTBackgroundRenal 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.MethodsWe analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre‐LT renal function by estimated glomerular filtration rate (eGFR) into low (<30 mL/min/1.73 m2) and high (≥30 mL/min/1.73 m2). Marginal donors were defined by criteria including donation after cardiac death, age ≥ 65, severe macrosteatosis (≥30%), or body mass index ≥ 40 kg/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.ResultsOf 13 279 LT recipients, 12 851 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).DiscussionGS 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. 10.1111/ctr.70123 http://onlinelibrary.wiley.com/termsAndConditions#vor