P152 Chronic kidney disease in liver transplant recipients: high prevalence but low risk of end-stage disease in contemporary practice

<h3>Background</h3> Previous studies have reported that up to 5–15% of liver transplant (LT) recipients develop end-stage kidney disease (ESKD) within 10 years post-transplantation. Chronic kidney disease (CKD) also independently drives cardiovascular disease (CVD) risk in this population. However, contemporary data on CKD and ESKD incidence post-LT remain limited. We aimed to evaluate the incidence and risk factors for CKD stage 3 or higher among LT recipients in Northern Ireland (NI). <h3>Methods</h3> We retrospectively analysed 216 LT recipients transplanted between January 2010 and December 2019 at the Regional Liver Unit in NI. CKD was defined as eGFR &lt;60 ml/min/1.73m² or albumin creatinine ratio (ACR) ≥3 mg/mmol according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Patients were classified by CKD stage at their most recent assessment. Multivariable logistic regression identified risk factors for CKD stage 3+ at follow-up. Time-to-event analysis detailed time from LT to CKD stage 3+ onset. <h3>Results</h3> Of the 216 patients, 48 (22.2%) died during the study period, with a median time from LT to death of 5.2 years (interquartile range (IQR) 3.1–8.7). The median post-transplant follow-up was 8.0 years (IQR 6.0–10.4). At the most recent assessment, 74 patients (34.3%) had no evidence of CKD, 105 (49.5%) had CKD stage 3a, 24 (11.1%) stage 3b, 10 (4.6%) stage 4, and 3 (1.4%) stage 5. Of the three patients classified as stage 5, two had received a kidney transplant post-LT and one was on haemodialysis. Among patients without pre-transplant CKD, the median time to CKD stage 3+ was 7.7 years (IQR 5.4–9.9). In multivariable logistic regression, older age at transplant (OR 1.04 per year, 95% CI 1.03–1.08, p=0.001) and pre-transplant diabetes mellitus (OR 3.23, 95% CI 1.44–5.19, p=0.019) were significant risk factors for CKD stage 3+ (table 1). <h3>Conclusions</h3> Our findings suggest that the previously reported high rates of ESKD after LT may not reflect contemporary clinical practice. CKD remains highly prevalent post-LT and contributes significantly to CVD in this vulnerable population. These results emphasise the need for proactive CKD management, including CVD risk factor control in LT recipients. We plan to further evaluate CKD and CVD prevention practices in this cohort to assess alignment with current guidelines. This single-centre retrospective study highlights the need for larger, multicentre studies to confirm these findings.