*Purpose: Postoperative acute kidney injury (AKI) is common after liver transplant (Oltx). It is associated with increased morbidity and mortality and is a risk factor for chronic kidney disease (CKD) following Oltx. We evaluated the impact of type of caval (IVC) reconstruction on post-operative AKI and eGFR at 1-year post-transplant.

*Methods: Data on 566 patients who received a primary oltx at a single center between 2012 and 2017 were retrospectively collected from a prospective database. Patients were divided according to the method used to reconstruct the IVC; Piggyback (PB, n=219), caval interposition (CC, n=293) and patients who underwent CC with venovenous bypass (VVBP, n=54). Primary outcomes were AKI at 48h postoperatively using KDIGO classification and calculated glomerular filtration rate (eGFR) at 1-year post-transplant.

*Results: 413 patients developed AKI (72.7%) and 75 patients (13.2%) required renal replacement therapy post oltx. The proportion of patients meeting KDIGO AKI stage 1, 2 & 3 was similar among the 3 groups (table 1, p=0.095). However, at 1-year post oltx, patients in the CC group were more likely to have eGFR < 60 mL/min/1.73m² (table 1, p=0.021). Interestingly, more patients at time of OLTX were hospitalized (ward or ICU) in the PB group ( 30.6%) and VVBP group (31.5%) compared to CC group (17.4%) (p=0.006) and patients in the PB group had a lower mean arterial pressure at time of anesthesia induction (p=0.043). In the PB group, more patients required hemodialysis (PB:18.7%, CC:9.22% VVBP:16.7%, p=0.006) and reexploration (PB:25.1% CC:14.0% VVBP:24.1%, p=0.004) post oltx.

*Conclusions: All 3 types of IVC reconstruction techniques have a similar incidence of postoperative AKI despite a selection bias toward PB in sicker patients. CC is associated with lower eGFR at 1-year post oltx.

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