*Purpose: End-stage renal disease (ESRD) post-liver transplant (LT) is associated with increased mortality, but ESRD incidence and risk factors in LT recipients (LTRs) remain poorly defined. Single-center studies suggest higher post-LT ESRD risk among Black LTRs, but this has not been evaluated in national data, and other sociodemographic risk factors have not been defined.

*Methods: Using SRTR data for 91,589 adult, first-time, deceased-donor LTRs 2002-2020 with pre-LT eGFR>15, we evaluated temporal trends in post-LT ESRD. We evaluated recipient characteristics (race, age, sex, MELD, pre-LT eGFR, HCV, diabetes, education, insurance) associated with the incidence of and time to post-LT ESRD (eGFR<20, kidney transplant or listing) using multivariable Cox regression. We calculated change in proportion of LTRs with ESRD within 1 year post-LT using logistic regression.

*Results: LTRs with vs. without post-LT ESRD were more likely to be Black (11.7% vs. 7.7%), be HCV-positive (42.0% vs. 39.7%), have diabetes (40.8% vs. 23.7%), and have pre-LT CKD (48.9% vs. 25.6%), and less likely to be male (64.8% vs. 68.2%) or complete high school (HS, 46.4% vs. 50.5%). In a multivariable model, Black race (aHR _1.501.63_1.78), HCV (aHR _1.061.12_1.18), educational attainment (aHR _0.880.93_0.99 >HS vs. 0.820.83_0.83 per 10 units), and diabetes (_2.202.32_2.46) remained independent predictors of ESRD. Risk of ESRD by 1 year post-LT increased post-2017 (Figure 2; post- vs. pre-2017 OR _1.331.46_1.60).

*Conclusions: Recipient characteristics such as Black race and diabetes are associated with increased post-LT ESRD risk. However, they alone do not explain the increase in 1-year ESRD risk post-LT since 2017, which warrants further investigation.

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