*Purpose: We aimed to identify the risk factors for combined liver-kidney transplantation (CLKT) vs. liver transplantation alone (LTA) in end stage liver disease (ESLD) patients with estimated glomerular filtration rate (eGFR) <60 ml/.min, not on dialysis.

*Methods: Using OPTN data, we studied adult ESLD patients who received deceased-donor CLKT [N=2016 (12.9%] or LAT [N=13,588 (87.1%)] in July 2002-Mar 2016 with a 4-point modification of renal disease (MDRD) equation-estimated glomerular filtration rate (e-GFR) of below 60 ml/min (stratified into CKD stage 3: 30-59 ml/min, CKD stage 4: 15-39 ml/min, and CKD stage 5: <15 ml/min) and not on maintenance dialysis (NOD). The outcome of the study was CLKT or LAT. We reported odds ratio (OR) and 95% confidence interval (CI) for CLKT vs. LTA associated with recipient, donor, and clinical variables.

*Results: Out of 15, 604 CLKT and LTA recipients with MDRD-eGFR <60 ml/min. 8,784 (56.3%) had CKD stage 3; 4,916 (31.5%) had CKD stage 4; and 1,891 (12.1%) had CKD stage 5. CKD stages 5 and 4 at WL and transplant were the strongest risk factors for CLKT vs. LTA (FIG.1). Strong non-renal risk factors for CLKT vs. LTA were WL-time, Black recipients, liver re-transplant, and DM (TAB. 1). Factors associated with stronger likelihood of LTA vs. CLKT were WL-MELD >35, donor age>60 years, WL-MELD 31-35, female recipient’s sex, and hepatocellular carcinoma (FIG. 1 & TAB 1). Transplant center volume rank in the middle or highest tertile was associated with a lower likelihood of CLKT vs. LTA than the lowest tertile (FIG. 2, TAB. 1).

*Conclusions: Advanced CKD, waitlist time, AA ethnicity, previous liver transplant and DM are strong risk factors favoring CLKT vs. LTA.

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