Kidney safety net utilization after liver transplant for acute alcohol-associated hepatitis

Liver transplants for acute alcohol-associated hepatitis have risen rapidly over the past decade in concert with higher demand and satisfactory patient and graft survival, yet little is known about this population's long-term renal outcomes. Using the United Network for Organ Sharing registry, we identified patients undergoing isolated orthotopic liver transplant for acute alcohol-associated hepatitis in the safety net kidney after liver transplant era (August 2017 to December 2023). We used entropy balancing to identify a comparative control group using patient demographics and kidney disease risk factors. Recipients with acute alcohol-associated hepatitis had both a higher relative risk of being listed for (relative risk 2.1; 95% CI 1.7-2.8; 10.2% vs 4.8%) and receiving a safety net kidney after liver transplant (relative risk 2.0; 95% CI 1.6-2.8; 6.2% vs 3.2%) compared to controls. Among patients who were not listed for a kidney transplant, liver recipients with acute alcohol-associated hepatitis had lower posttransplant mean estimated glomerular filtration rates (69.0 vs 75.6 ml/min/1.73m², P < .001) and were more likely to have stage 3 or 4 chronic kidney disease. It remains unclear whether these inferior renal outcomes are due to the underlying pathophysiology of acute alcohol-associated hepatitis, care practices (i.e., delays in transfer to the transplant center), or a combination of clinical factors.