Characterizing Renal Function Predictors and Outcomes in Liver Transplant Recipients Who Have Preoperative Renal Dysfunction

Background:The 2017 OPTN criteria for simultaneous-liver kidney (SLK) transplantation is utilized for patients with end stage liver disease and renal dysfunction.However, SLK eligible patients often receive liver-alone transplants (LT) for a number of reasons.Here, we aimed to characterize the post-LT trajectory of recipients with preoperative renal dysfunction and identify possible predictors of post-LT renal function.Methods: This was a retrospective, single-center cohort study with all adult patients who underwent LT between 2013 and 2020 who required preoperative nephrology evaluation.Data was collected on baseline characteristics, preoperative renal function parameters, and outcomes, including mortality and post-LT renal function.SLK eligibility was determined via the OPTN criteria, and comparisons were made between SLK ineligible and eligible patients.Predictors of post-LT renal outcomes were characterized with multivariable logistic regression.Results: 48 LT recipients were included with a mean age of 51.5 years, male predominance (69%), and mostly affected by alcoholic cirrhosis (48%).7 patients met OPTN criteria (retrospectively applied), and none underwent SLK.Overall, 18 (38%) patients had CKD, 39 (83%) had pre-LT AKI, and 22 (46%) had pre-LT requirement for dialysis.4 (9%) patients had abnormal renal ultrasound findings (i.e.atrophy, scarring), 18 (38%) had pre-LT proteinuria, and 5 (10%) had a protein-creatinine ratio (PCR) >2mg/g.Post-LT renal outcomes were notable for 26 (54%) requiring dialysis, 4 (8%) kidney listings, 3 (6%) kidney transplants, 33 (66%) having 30-day post-LT GFR <60mL/min, and 26 (52%) having 1-year post-LT GFR <60mL/min (Table 2).Pre-LT abnormal ultrasound findings predicted post-LT kidney listing (OR: 16.2, p=0.03), kidney transplant (OR: 35.0, p=0.02).Pre-LT proteinuria predicted post-LT need for dialysis (OR: 5.3, p=0.02) and pre-LT PCR >2mg/g predicted 1-year post-LT GFR <30mL/min (OR: 9.89, p=0.049).Conclusions: Regardless of SLK eligibility, LT recipients with pre-LT renal dysfunction continued to have significant rates of post-LT dialysis, readmissions, and low GFR.Pre-LT abnormal ultrasound findings, proteinuria, and elevated PCR may help predict post-LT renal function and can potentially guide decisionmaking, warranting further investigation.