Liver transplant (LT) recipients are at high risk of posttransplant renal disease but the extent of renal disease is often unrecognized in the pretransplant setting. Native kidney biopsies in LT recipients may inform the status of pretransplant renal disease. Methods: We performed a prospective observational study of LT recipients with kidney biopsy performed at the time of transplant. Results: Of the 63 patients enrolled, the most common etiology of liver disease was HCV (n=31) and alcohol (n=14). Kidney biopsies revealed a specific pathology in 26 patients, with MPGN in 6, diabetic nephropathy in 1, FSGS in 5, interstitial fibrosis in 2 and arterionephroclerosis (ANS) in 12. MPGN was the most common diagnosis in HCV+ patients while FSGS was most common in HCV negative; ANS was equally represented in both. Patients with abnormal biopsies did not differ clinically from those with normal biopsies (see table 1). Stratification of the cohort by HCV-related liver disease or AKI at time of transplant (as defined by RIFLE criteria) did not correlate with native kidney biopsy findings. Serum creatinine at 6 months post transplant did not differ by biopsy result. Conclusions: Renal parenchymal disease at time of LT is common and not predicted by clinical characteristics. Pathologic abnormalities on biopsy do not correlate with short term renal outcomes.

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