*Purpose: Induction choices for kidney-after-liver transplant recipients are variable. We examined the impact of kidney induction types on kidney graft and patient survival in liver transplant recipients.

*Methods: We utilized the SRTR database through the end of 2015 to study kidney grafts and patients’ outcomes of all kidney-after-liver transplant recipients in the United States. We grouped recipients by induction type into three groups: depletional (N=687), non-depletional (n=558), and no induction (steroid only) (n=340). We studied patients and kidney allografts survival using Cox PH regression, with transplant center included as a random effect. These models were adjusted for kidney and liver induction, recipient and donor age, gender, HLA mismatches, payor type, living kidney, dialysis status, time from liver engraftment, hepatitis C status, DM at time of kidney transplant. Additionally, we analyzed a sub-cohort of recipients only on tacrolimus and mycophenolate maintenance.

*Results: Baseline characteristics are listed in (Table 1). The Kaplan-Meier curves showed statistically significant lower recipients and kidney allografts survival in the no induction group (Figures 1 and 2). Rejection and re-hospitalization rates were not statistically different between groups. In the multivariate model, as compared to no induction, only depletional induction was associated with improved patient survival [HR 0.70, 95% CI (0.53, 0.93), P 0.012] and kidney allograft survival [HR 0.62, 95% CI (0.39, 0.98), P 0.04]. Living-kidney donation was associated with improved kidney survival [HR 0.53, 95% CI (0.34, 0.82), P 0.004]. Results were similar in both cohorts.

*Conclusions: Depletional kidney induction was associated with improved patient and kidney graft survival for those with prior liver transplants. Depletional induction may be the preferred induction for kidney-after-liver transplant recipients.

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