Current combined Liver-kidney allocation protocols allocate dual organs based on sustained glomerular filtration rates (eGFR) of 30ml/min or less. It is unclear whether milder renal dysfunction due to Chronic kidney disease (CKD-3) alone, associates with rapid progression to ESRD post orthotopic liver transplantation (OLT). A new approved UNOS combined organ allocation proposal will consider CKD3 as candidates for dual organ allocation but only when AKI coexists. We manually reviewed charts of all adult OLTs at our institution between 1/2010 and 12/2013, excluding recipients of dual-organ transplants. We categorized recipients with pre-OLT CKD3 (eGFR 30-59 ml/min), and noted peri-OLT acute kidney injury (AKI) (25% fall in GFR in peri-OLT period [+/- 4wks]) as well as dialysis requirement, and followed post-OLT outcomes (end stage renal disease (ESRD) and death). Among 290 OLT-recipients who had complete data for analysis, 66 had pre-OLT CKD3, 137 had AKI, of which 36 required dialysis (<4 wks total duration). During the median follow up of 1220 days, 22 patients (7.6%) developed ESRD requiring dialysis or transplantation, and 70 died (24.1%). In unadjusted analysis, CKD3 was associated with significantly increased odds of post-OLT ESRD (14/66; OR-7.27; P<0.001). ESRD developed in the CKD3 cohort at median of 305 days post-OLT (IQR: 67-985 days). In adjusted Cox models (including recipient demographics, comorbidities, AKI, dialysis), CKD3 had a strong independent association with post-OLT ESRD (adjusted HR 3.08; P=0.02), even with AKI included in the model. CKD was not associated with post-OLT mortality (adjusted HR 1.51, 95% CI 0.76-2.97). AKI, however, was associated with post-OLT survival (adjusted HR 1.79; P=0.01), albeit only in the first year post OLT, but not after 1-yr. In conclusion, the association of AKI with early post-OLT survival, but not survival after 1 year likely reflects a more severe peri-operative course in these patients. Pre-OLT CKD3 was associated with increased risk of post-OLT ESRD independent of AKI. This finding, if generalizable in larger cohorts is important for organ allocation, especially since recipients of OLTs with CKD3 currently need to gain time on the kidney waitlist post OLT.

CITATION INFORMATION: Faddoul G, Liriano-Ward L, Chang P, Azzi Y, Chauhan K, Nadkarni G, Nair V, Kent R, Lerner S, Coca S, Heeger P, Florman S, Thomas S, Menon M. Pre-OLT CKD-3 Increases Post-OLT ESRD and AKI Impacts Early Post-OLT Survival. Am J Transplant. 2017;17 (suppl 3).

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