The evolving use of higher risk grafts is associated with an increased incidence of acute kidney injury after liver transplantation

Joanna A Leithead, Neil Rajoriya, Bridget K Gunson, Paolo Muiesan, James W Ferguson

Research output: Contribution to journalArticlepeer-review

58 Citations (Scopus)


BACKGROUND & AIMS: The growing discrepancy between supply and demand for liver transplantation has necessitated a greater use of higher risk grafts. Donation after Circulatory Death (DCD) liver transplant recipients have an increased frequency of acute kidney injury (AKI). We hypothesised that other higher risk grafts might also impact negatively on renal function. Our aim was to examine the effect of the evolving use of higher risk grafts on the incidence of post liver transplant AKI.

METHODS: Single-centre study of 1152 patients undergoing first-single-organ liver transplantation for chronic liver disease 01/2000-12/2011. To assess the impact of the evolution of graft quality over time; donor/graft/recipient variables were compared over three 4-year periods.

RESULTS: Pretransplant recipient renal function improved during follow-up (p<0.001), and the median postoperative day-1 (p<0.001), -2 (p<0.001), and -3 (p<0.001) tacrolimus trough levels fell. The proportion of patients receiving a higher risk graft was 31.8% in 2000-2003, 40.9% in 2004-2007, and 59.1% in 2008-2011 (p<0.001). There was a progressive increase in AKI (2000-2003, OR 1.00; 2004-2007, OR 1.43; 2008-2011, OR 2.40, p<0.001). After adjusting for recipient variables increasing recipient warm ischaemic time (p=0.019), DCD transplantation (p<0.001), donor age ≥60 years (p=0.020), and donor body mass index ≥30 kg/m(2) (p<0.001) were independent predictors of AKI.

CONCLUSIONS: The increasing use of higher risk liver grafts is associated with an increased incidence of AKI. These findings support the need for therapies that minimise the hepatic ischaemia-reperfusion injury.

Original languageEnglish
Pages (from-to)1180-6
Number of pages7
JournalJournal of Hepatology
Issue number6
Publication statusPublished - Jun 2014

Bibliographical note

Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


  • Acute Kidney Injury
  • Adult
  • Body Mass Index
  • End Stage Liver Disease
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Incidence
  • Liver Transplantation
  • Logistic Models
  • Male
  • Middle Aged
  • Morbidity
  • Obesity
  • Reperfusion Injury
  • Risk Factors
  • Tissue Donors
  • Treatment Outcome
  • Warm Ischemia


Dive into the research topics of 'The evolving use of higher risk grafts is associated with an increased incidence of acute kidney injury after liver transplantation'. Together they form a unique fingerprint.

Cite this