*Purpose: In the wake of improvement in engraftment and survival rates after liver transplantation (LT) in Japan, the onset of late complications, such as renal dysfunction, have become more apparent and pose a significant problem. Focusing on abdominal aortic calcification (AAC), which can be an indicator of systemic arteriosclerosis, we evaluated the effect of AAC in liver transplant patients on postoperative renal function.

*Methods: Of the total 174 LTs between 2008 and 2020, 104 LTs with normal renal function before surgery were included, and 59 cases in the AAC group and 45 cases in the non-AAC group were compared. Using the Agatston method, the AAC volume was automatically calculated for calcifications located in the abdominal aorta (from the origin of the renal artery to the iliac bifurcation) with attenuation greater than the predefined 130 Hounsfield units level. Chronic kidney disease (CKD) was defined as glomerular filtration rate (eGFR) < 60 mL/ min/ 1.73 m² lasting for 3 months or longer.

*Results: 1. The AAC group had older and predominantly male patients, with lower preoperative creatinine and eGFR levels. 2. There was no significant difference in postoperative tacrolimus blood levels between the two groups. 3. There was no significant difference in the onset of postoperative CKD; however, differences were observed in cumulative postoperative CKD incidences (AAC group vs non-AAC group) at 1 year (27.9% vs 13.8%; p < 0.05), 3 years (37.7% vs 23.3%; p < 0.05), and 5 years (48.7% vs 30.7%; p < 0.05). These results suggest that AAC might be involved in the development of CKD.

*Conclusions: LT patients with normal preoperative renal function who have AAC have a higher risk of developing CKD.

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