Introduction: Renal dysfunction before and after liver transplantation is a significant predictor of graft survival (GS). This study aims to characterize the relationship between early changes in renal function (RF) and GS post-liver transplantation.

Methods: Adult patients in the OPTN/UNOS database who received a primary liver transplant between 2002 & 2011 due to HCV, alcoholic cirrhosis and HCC were eligible. RF, measured by eGFR, at time of transplant and at 12 months (M) was categorized by CKD stage. Impact of a shift in CKD stage on the risk of graft failure (GF) was assessed using Cox hazards model with left truncation.

Results: A total of 28,014 patients with eGFR data at time of transplant were included (mean age 54 years; 71% male; 4-year median follow-up). Of these, 41% were transplanted for HCV cirrhosis, 29% for alcoholic cirrhosis and 30% for HCC. At transplant, 37%, 29%, 21%, 6% and 7% of patients were in CKD stage 1, 2, 3, 4, and 5, respectively with 95% of HCC patients in CKD stage 1, 2, or 3 vs. 82% of alcoholic and 85% of HCV patients. More severe CKD was significantly associated with increased risk of GF (Hazard ratio (HR) per unit increase = 1.13; 95% CI=1.11-1.16) regardless of diagnosis. Patients in CKD stage 2 or 3 who had a ≥1worsening in CKD stage by M12 had a significantly greater risk of GF at 4 years vs. patients who remained in their respective CKD stage (Table). Patients in CKD stage 1 who progressed to stage 2 or 3 at M12 were at decreased risk of GF (HR=0.64 and 0.76) vs. patients who remained at CKD stage 1 whereas patients who progressed to stage 4 or 5 were at increased risk of GF (HR=2.70 and 2.24). This result is independent of liver diagnosis (Stage by diagnosis 2-way interaction; p=0.588).

Conclusion: One stage worsening in CKD in the first 12 months is associated with a significantly increased risk of GF at 4 years. Poor prognosis for CKD stage 1 patients at M12 merits further investigation.

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