*Purpose: We examined the perioperative and intraoperative risk factors associated with post-operative acute kidney injury (AKI) at post-op 7 days and 30-day estimated glomerular filtration rate (eGFR).

*Methods: We linked data on 618 adult, primary liver transplant recipients between 2008-2018 at a single academic medical center with the Multicenter Perioperative Outcomes Group record. eGFR was calculated using the MDRD 4 equation. AKI within 7 days of LT was defined according to Kidney Disease Improving Global Outcomes criteria and analyzed using logistic regression. Day 30 eGFR was dichotomized, and the odds of <60 mL/min were modeled via logistic regression, with day 7 AKI as the main predictor.

*Results: Median age of the cohort (N=618) was 56 years (Q1=48, Q3=61), 34% were female, 80.6% were Caucasian. Median lab MELD-Na at LT was 19.3 (Q1=12.7, Q3=26.1). 22.7% had viral hepatitis, 11.5% had alcoholic liver disease, 19.4% had NASH/cryptogenic cirrhosis. 219 (35.7%) patients developed AKI stage 2 or 3 within 7 days of LT (Table 1).

Patients administered cryoprecipitate and intermediate dosages of norepinephrine during LT have increased susceptibility to early AKI. The median eGFR at day 30 was 37.5 (Q1=56.3, Q3= 23.8), with 494 (78.2%) having an eGFR <60 mL/min. AKI within 7 days of LT (OR=14.2 [95%CI: 7.7-26.3]; P<0.001) was a significant predictor of eGFR<60 at day 30 (Table 2).

*Conclusions: Preoperative comorbidities including anemia, electrolyte disorders, and high BMI were significant predictors of early AKI. Presence of stage 2-3 AKI during first 7 days of LT adversely impacts renal function at day 30 following LT, a finding that may help target renal protective strategies to patients at high risk of diminished renal function.

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