Introduction: Patients with cirrhosis are at risk for acute kidney injury (AKI) with higher prevalence and mortality. Data are limited on the prevalence, natural history, and predictors of AKI among cirrhosis patients listed for liver transplantation (LT). Methods: Medical charts were reviewed to collect data on AKI episodes between LT listing (2009-2014) and removal from list on prospectively recruited LT-listed patients for 1 translational study at our liver center. AKI was defined based on the 2012 Working Party proposal for revised classification system of renal dysfunction. Renal function was estimated with the modified diet in renal disease (MDRD-6) using age, gender, race, serum creatinine, blood urea nitrogen, and albumin. Results: Of 197 patients (mean age 55 years, 63% m, 36% HCV, and 27% NASH, 17% HCC, listing median MELD 18, listing median MDRD 67) between LT listing (10 listed for simultaneous kidney or SLK) and removal from list (77 LT, 23 deaths, 18 other reasons, and 79 waiting for LT), AKI occurred in 66 (3 SLK-listed) patients with 27 (41%) based on increase in SC by ≥0.3 mg/dL. AKI required intervention in 42 (64%) with hospitalization in 37 (56%, AKI as reason for admission in 10). Median hospital stay was 12 days, including ICU stay of 2 days. AKI was pre-renal in 35 (fractional excretion of sodium <1% in 19) with hypovolemia in 28 (diuretics in 12), sepsis in 2, and hepato-renal syndrome (HRS) in 5. AKI responded well using fluids (n=35), withholding medications (n=33), antibiotics (n=11), vasoconstrictors (n=17), and dialysis (n=5 for 1-18 days with CRRT in 4). Median MDRD-6 at discharge was 50 compared to admission MDRD-6 of 32. Of 66, 20 developed second episode, and 10 developed third AKI episode with their characteristics similar to first episode. Patients with AKI compared to 131 without AKI differed for mean age (57±9 vs. 53±10 yrs.), pre-existing chronic kidney disease (38 vs. 17%, p=0.002). Listing MDRD-6 (57±23 vs. 80±39, p<0.0001) and listing MELD (21±6 vs. 18±7, p=0.01). Patients with AKI had higher pre-LT mortality (16 vs. 7%, p=0.02) with lower LT probability (28 vs. 49%, p=0.02) and lower MDRD-6 at LT (47±26 vs. 78±42, p=0.0009). Of 84 patients with available time-dependent data, AKI occurred in 27 (32%) of patients over a median follow-up of 3 months. Controlling for other variables, listing MDRD-6 increase by 10 points reduced AKI occurrence by 18% with HR (95% confidence interval [CI]): 0.82 (0.68-0.986). Conclusion: AKI in LT-listed patients occurs frequently, is associated with poor outcomes, and is predicted by renal function at listing. Prospective studies are needed as basis for developing better strategies to prevent AKI in LT-listed patients and on guidelines for SLK listing.