P1658RENAL RECOVERY AFTER LIVER TRANASPLANTATION ALONE IN PATIENTS WITH LIVER CIRRHOSIS AND SEVERE CHRONIC KIDNEY DISEASE WITH NORMAL KIDNEY SIZE

Background and Aims Most guidelines recommend simultaneous liver-kidney transplantation (SLKT) in patients with liver cirrhosis (LC) and severe chronic kidney disease (CKD) over liver transplantation alone (LTA). CKD, however, is not irreversible. This study evaluates the reversibility of kidney disease after LTA based on kidney size. Method In this single-center retrospective study, we classified 90 patients with LC and severe CKD into 3 groups: normal kidney-LTA (NK-LTA, n=39), small kidney [both <9cm]-LTA (SK-LTA, n=40), and small kidney-SLKT (SK-SLKT, n=11). Baseline characteristics and renal recovery and survival outcomes were compared among 3 groups. Results The NK-LTA group had a lower percentage of hepatocellular carcinoma, a higher pre-LT eGFR, and a shorter duration of eGFR at <60 ml/min and pre-LT dialysis. This group, however, was older, received livers from a higher percentage of deceased donors and had a higher Child-Pugh score. Renal recovery, defined as no hemodialysis (HD) after LT, was found in 79% of those in the NK-LTA group, which was higher than 7.5% of those in the SK-LTA group. Renal survival, defined as patient survival without progression to HD or kidney transplant was found in 56% of patients in the NK-LTA group, which was higher than 2.5% of those of the SK-LTA group. Conclusion Patients with LC and severe CKD with normal kidney size may experience reversible kidney disease after LTA. Therefore, kidney after liver transplantation is recommended over SLKT for these patients.