Clinical outcomes of patients with hepatorenal syndrome after living donor liver transplantation

Abstract

Liver transplantation (LT) is the treatment of choice for hepatorenal syndrome (HRS). However, the clinical benefits of living donor liver transplantation (LDLT) are not yet well established. We, therefore, investigated the outcomes of patients with HRS who underwent LDLT and patients with HRS who received transplants from deceased donors. This study focused on 71 patients with HRS out of a total of 726 consecutive adult Korean patients who underwent LT at a single Asian center. We compared 48 patients who underwent LDLT with 23 patients who underwent deceased donor liver transplantation (DDLT). Patients with HRS showed poorer survival than patients without HRS (P ¼ 0.01). Poorer survival was associated with higher in-hospital mortality for patients with HRS (18.3% versus 5.2%, P < 0.001). In comparison with DDLT, LDLT was associated with younger donors and shorter ischemic times. The survival rate with LDLT was significantly higher than the survival rate with DDLT (P ¼ 0.02). Among patients with high Model for End-Stage Liver Disease scores (!30) or type 1 HRS, the survival rates for the LDLT group were not inferior to those for the DDLT group. LDLT significantly improved recipient survival after adjustments for several risk factors (hazard ratio ¼ 0.20, 95% confidence interval ¼ 0.05-0.85, P ¼ 0.03). Kidney function was significantly improved after LT, and there was no difference between LDLT and DDLT. No patients in the HRS cohort required maintenance renal replacement therapy. In conclusion, LDLT may be a beneficial option for patients with HRS. Liver Transpl 18:1237-1244, 2012. V C 2012 AASLD.Received November 28, 2011; accepted June 9, 2012. See Editorial on Page 1138Hepatorenal syndrome (HRS) is characterized by the rapid progression of functional renal failure, and patients with HRS have an extremely poor prognosis. 1 Renal dysfunction associated with HRS not only affects overall survival but also influences outcomes and survival after liver transplantation (LT). [2][3][4] LT is an effective cure for both liver disease and associated renal failure and is, therefore, the treatment of choice for patients with end-stage liver disease and HRS. [5][6][7] Long-term survival after LT for patients with HRS is excellent, with the 3-year survival rate approaching Additional Supporting Information may be found in the online version of this article.

Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study

“…We were not able to determine the incidence of hepatorenal syndrome (HRS) prior to transplant, and therefore were not able to test the effect of HRS on the subsequent development of post-transplant CKD. However, recent single center studies have found equivalent renal outcomes in LDLT and DDLT patients with HRS (21, 22). Our analysis adjusted for serum creatinine at the time of transplant, and, although serum creatinine is an imperfect proxy for the magnitude of pre-existing renal dysfunction in patients with liver disease, there is no reason to think that serum creatinine differentially represents renal dysfunction in LDLT versus DDLT candidates, However, before drawing strong inference from our findings, they should be validated by other groups.…”

Influence of hepatorenal syndrome on outcome of living donor liver transplantation: A single‐center experience in 357 patients

“…reported that eight patients out of 32 (25%) died within the first month after DDLT . It was also reported that in‐hospital mortality was significantly higher in HRS recipients than in non‐HRS . In this regard, however, it has not been fully elucidated why the short‐term outcome in HRS patients is worse than in non‐HRS.…”

“…23 It was also reported that in-hospital mortality was significantly higher in HRS recipients than in non-HRS. 12 In this regard, however, it has not been fully elucidated why the short-term outcome in HRS patients is worse than in non-HRS. In the present study, there was no difference in the causes of death within 1 year after LDLT between Group-HRS and Group-Non-HRS (Table 2).…”

“…Considering the small graft volume from a living donor, the validity of LDLT for severe liver disease, such as HRS, remains unknown. 12 The aim of the present study was thus to evaluate the influence of HRS on the patient, as well as renal, outcome in LDLT.…”

Living donor liver transplantation in high Model for End‐Stage Liver Disease score patients

“…Second, warnings regarding inferior outcomes of LDLT in high acuity/high MELD candidates also served as deterrents . This was the context surrounding the 3 seminal reports from 3 leading LDLT centers worldwide specifically focused on LDLT for candidates with HRS, as defined by the International Ascites Club (Table ) …”