P122 Major adverse kidney events and associated factors following liver transplantation: a retrospective analysis

<h3></h3> Despite favourable survival following orthotopic liver transplantation, renal dysfunction is common, related to pre-operative renal dysfunction, peri-operative hypoperfusion and nephrotoxicity from anti-rejection therapy. Although the incidence of acute kidney injury (AKI) is well demonstrated, there is a lack of studies on Major Adverse Kidneys Events (MAKE): a composite outcome of the clinically significant consequences of AKI. This analysis identified patients who developed MAKE within 1 year of liver transplantation and studied the association with acute kidney injury, chronic kidney disease (CKD), demographic and peri-operative factors A retrospective analysis was performed of patients who underwent liver transplantation at the Queen Elizabeth Hospital Birmingham between May 2016 and June 2019. Data were obtained from the NHS Blood and Transplant (NHSBT) Database along with the hospital’s electronic notes system. AKI was defined according to the KDIGO criteria. MAKE was defined according to criteria devised by the NIDDK (National Institute for Diabetes and Digestive and Kidney Diseases) and its occurrence was studied at 30, 90, 180 and 365 days. MAKE occurred in 57% of 503 patients with the greatest incidence at 180 days. Early MAKE were most frequently due to the requirement of renal replacement therapy (66% at 30 days) with later MAKE most frequently due to a decline in eGFR of &gt;25% (72% at 180 days). Occurrence of MAKE was significantly associated with greater age (p&lt;0.001, MAKE30 to 365), female gender (p= 0.001–0.021, MAKE30 to180), pre-operative eGFR (p=0.001–0.046, MAKE30 to180), warm ischaemic time (p=0.005–0.032, MAKE30 and 180), volume of transfused blood products (p=0.001–0.003, MAKE30 and 365) and AKI in the first 7 days (p&lt;0.001, MAKE 30 to 365). The occurrence of MAKE at all time points was significantly associated with incidence of CKD at 365 days (p=0.001). This analysis demonstrates the prevalence of MAKE post liver transplantation and significant associations with early post-operative renal dysfunction (AKI) and later chronic kidney disease. Demographic, pre and peri-operative factors are significantly associated with the occurrence of MAKE at intervals over 365 days, with most the conserved being age, gender, pre-operative creatinine and eGFR, and occurrence of AKI. Such patients may benefit from enhanced post-operative surveillance to minimise progression of renal dysfunction and manage associated morbidity. Further research is warranted to better identify the causative factors in this co-hort.