*Purpose: Non-alcoholic steatohepatitis (NASH) has emerged as a leading cause of cirrhosis, and obesity-associated comorbid conditions, including renal disease have become more prevalent. Obesity predisposes the kidney to hyperfiltration injury, potentially impairing recovery from acute kidney injury. Prospective identification of patients at risk for renal dysfunction has been limited by poor performance of renal function estimating equations among cirrhotics. To better understand the relationship between obesity at time of liver transplantation and likelihood of renal disease progression, we examined likelihood of listing for kidney transplantation (KT) after liver transplant alone (LTA) by obesity class.

*Methods: Utilizing data from SRTR (2005-2018), 68,607 LTA recipients were studied. Fine and Gray competing risks models were used to analyze the association of obesity at time of LTA with likelihood of subsequent listing for KT.

*Results: 27.4% of LTA recipients were obese (BMI>30kg/m2) and were 10% more likely to require listing for KT following LTA compared to non-obese (aHR: 1.10, 95%CI: 1.01-1.20). This risk increased with obesity class, with no significant risk difference among recipients with Class I obesity but 37% higher risk among Classes II and III (BMI: >35kg/m²) recipients compared to non-obese (aHR: 1.37, 95%CI: 1.17-1.56). Moreover, recipients with Classes II and III obesity at time of LTA compared to non-obese were 57% more likely to be listed for KT within their first year post-LTA (aHR: 1.57, 95%CI: 1.18-2.10).

*Conclusions: These findings suggest obesity was a risk factor for failure of renal recovery and/or renal disease progression post-LTA and may further confound identification of renal dysfunction and/or prediction of renal recovery among cirrhotics.

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