Kidney Outcomes Following Liver Transplantation: A Single-Center Experience

Background: Acute kidney injury (AKI) at the time of liver transplantation is a common comorbid condition that increases morbidity and mortality. The leading causes of liver disease share the many of the same comorbid conditions that are associated with chronic kidney disease. As such, kidney disease has been reported to be present in up to 80% of patients with liver disease. Hepatorenal syndrome, a potentially reversible cause of kidney injury which accounts for a large proportion of AKI in this patient population, affects 15-20% of all liver transplant patients, while prevalence of other causes of peri-transplant AKI is variable. Utilization patterns of renal replacement therapy (RRT) in the peri-transplant period varies among different transplant centers and depends on local center protocols. To combat morbidity associated with long-term advanced kidney disease, United Network for Organ Sharing (UNOS) implemented Safety Net critera for kidney allocation after liver transplant in 2017, however its use has been limited. Methods: Retrospective chart review of blinded EMR records of patients who received liver transplantation at a single transplant center. Results: Renal replacement therapy (RRT) utilization in a large-volume transplant center over a 4-year period (2021-2024) was assesed. During that time, 947 liver transplants were performed, with an additional 120 patients receiving simultaneous liver and kidney (SLK) transplantation. Among the patients who did not meet criteria for SLK, 637 (67%) patients required RRTduring the peri-transplant period. Dialysis dependence persisted in 14% of patients at the time of discharge. During the period of 2021-2023, 71 of 654 (11%) of liver only transplant patients were referred for kidney transplant evaluation under the Safety Net criteria, with 36% of referred partients deemed ineligible for transplantation, and 7 patients (10%) receiving kidney transplant after liver transplantation. Conclusion: AKI is a common comorbidity among patients undergoing liver transplantation. In a large volume liver transplant center, RRT is frequently used for care of patients in the peri-transplant period. While most patients recover to come off RRT at the time of discharge, many have residual kidney disease. Safety Net programs remain available but inadequately utilized for this patient population.