Kidney Transplant in patients with liver cirrhosis and advanced CKD remains debatable. The 2012 simultaneous liver kidney transplant (SLKT) summit guidelines recommend SLKT in patients with liver cirrhosis and chronic kidney disease with 6-variable MDRD e-GFR < 40 ml/min/m2. The purpose of our study was to assess the kidney outcomes in liver cirrhotic patients with CKD receiving liver transplant alone (LTA). We identified 136 patients who underwent LTA from Jan 2005 to August 2015 at our center. Of these, 8 had e-GFR (MDRD-6) < 40 ml/min/m2 for at least 3 months prior to LTA and were selected. The mean e-GFR, urine protein, and 24 hour urine creatinine clearance in these 8 patients was 19.7 ml/min/m2, 57.5 mg/24 hours, and 34.9 ml/min respectively a month pre-LTA. The kidney biopsies Pre-LTA in 6 patients were normal but 2 had focal mild interstitial fibrosis with no other pathology. The kidney ultrasound was normal in all except one patient who had echogenic but normal size kidneys. The mean follow up time post-LTA was 57.7±3.4 months. The e-GFR improved significantly post-LTA in all 8 patients with mean e-GFR (ml/min/m2) at 1 month (49.8), 3 months (44.5), 6 months (45.8), 12 months (48.9), 24 months (47.9), and 36 months (45.1) post-LTA significantly higher than mean e-GFR pre-LTA (19.7) with p-values ≤ 0.005 in all cases. See figure 1 for e-GFR change 3 months pre- to 3 years post-LTA. None of the patients developed ESRD and one patient died at 7 years post-LTA due to breast cancer. In conclusion, the low e-GFR (< 40 ml/min/m2) alone in the absence of significant proteinuria or other markers of kidney disease should not be an absolute criterion for SLKT in patients with liver cirrhosis. Consequently 2012 SLKT guidelines must be revised to avoid unnecessary kidney allocation to patients with liver cirrhosis with low GFR alone.

CITATION INFORMATION: Singh N, Ahmadzadeh S, Amin B, Marahatta R, Shokouh-Amiri H, McMillan R, Zibari G. Kidney Outcomes in Patients with Liver Cirrhosis and Chronic Kidney Disease Receiving an Orthotopic Liver Transplant Alone. Am J Transplant. 2016;16 (suppl 3).

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