Outcome of Patients With Hepatorenal Syndrome Type 1 After Liver Transplantation: Hangzhou Experience

Xu, Xiao; Ling, Qi; Zhang, Min; Gao, Feng; He, Zhi Min; You, Jingya; Zheng, Shusen

doi:10.1097/tp.0b013e3181a4430b

Cited by 37 publications

(40 citation statements)

References 37 publications

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“…Hepatorenal syndrome occurs predominantly in advanced cirrhosis and also develops in severe liver failure, and may accompany the worst prognosis among all the complications of cirrhosis. There has been a consensus that pre-transplant renal dysfunction was a strong predictor of poor prognosis after LT, especially in patients with high MELD score [15], [30], [31]. In some LT candidates with severe kidney impairment, renal function maybe deteriorated after LT and combined liver kidney transplantation should be considered [15], [32].…”

Section: Discussionmentioning

confidence: 99%

“…The specialists from Infectious Diseases Department chose therapies and carried out ALSS treatment 1–3 times per week based on the condition of patients and the facility (availability of plasma or machine). The decision to initiate hemodiafiltration were made by consultant nephrologists to prevent uremia or immediate death from the adverse complications of renal failure [15]. In principle, patients with coagulopathy were indicated for plasma exchange (PE); patients with hepatic encephalopathy were given PE plus plasma perfusion or continuous hemodiafiltration.…”

Section: Methodsmentioning

confidence: 99%

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Downgrading MELD Improves the Outcomes after Liver Transplantation in Patients with Acute-on-Chronic Hepatitis B Liver Failure

Ling

Wei

et al. 2012

PLoS ONE

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BackgroundHigh score of model for end-stage liver diseases (MELD) before liver transplantation (LT) indicates poor prognosis. Artificial liver support system (ALSS) has been proved to effectively improve liver and kidney functions, and thus reduce the MELD score. We aim to evaluate whether downgrading MELD score could improve patient survival after LT.Methodology/Principal FindingsOne hundred and twenty-six LT candidates with acute-on-chronic hepatitis B liver failure and MELD score ≥30 were included in this prospective study. Of the 126 patients, 42 received emergency LT within 72 h (ELT group) and the other 84 were given ALSS as salvage treatment. Of the 84 patients, 33 were found to have reduced MELD score (<30) on the day of LT (DGM group), 51 underwent LT with persistent high MELD score (N-DGM group). The median waiting time for a donor was 10 for DGM group and 9.5 days for N-DGM group. In N-DGM group there is a significantly higher overall mortality (43.1%) than that in ELT group (16.7%) and DGM group (15.2%). N-DGM (vs. ECT and DGM) was the only independent risk factor of overall mortality (P = 0.003). Age >40 years and the interval from last ALSS to LT >48 h were independent negative influence factors of downgrading MELD.Conclusions/SignificanceDowngrading MELD for liver transplant candidates with MELD score ≥30 was effective in improving patient prognosis. An appropriate ALSS treatment within 48 h prior to LT is potentially beneficial.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Downgrading MELD Improves the Outcomes after Liver Transplantation in Patients with Acute-on-Chronic Hepatitis B Liver Failure

Ling

Wei

et al. 2012

PLoS ONE

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“…Liver transplantation alone had been considered the treatment of choice for patients with cirrhosis and Type 1 HRS. Although some centers have reported HRS resolution posttransplant from 58% to 98% of patients [13,14], our study clearly demonstrates a distinct population of ESLD patients with Type 1 HRS who at approximately three years posttransplant fail to have significant native renal function. The ideal time for renal scanning post-transplant is yet to be determined, and requires further investigation and likely serial renal scans.…”

Section: Discussionmentioning

confidence: 85%

Native renal function after combined liver-kidney transplant for type 1 hepatorenal syndrome: initial report on the use of postoperative Technetium-99 m-mercaptoacetyltriglycine scans

et al. 2013

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SummaryType 1 hepatorenal syndrome (HRS) is characterized by rapid deterioration of renal function. We sought to assess native kidney function after combined kidney-liver transplant (CLKTx) performed for type 1 HRS. We performed a retrospective, cross-sectional, single-center study. All patients with Type 1 HRS who received a CLKTx at the University of California, San Francisco from 1997 to 2007 were screened for enrollment. Patients with a baseline estimated glomerular filtration rate (eGFR) ! 30 ml/min/1.73 m 2 were eligible. Twenty-three patients were identified and consented to receive a Technetium-99 m-mercaptoacetyltriglycine (MAG3) nuclear scan to measure the native kidney contribution to overall renal function. Only 4 of the 23 subjects (17.4%) demonstrated native renal function that consisted of a contribution ! 50% of total renal function. Several factors and comorbidities such as age, gender, race, duration of HRS, need for and duration of renal replacement therapy, need for pressors, urine sodium, proteinuria, and use of octreotide/midodrine were analyzed and not found to be significant in predicting native renal function. The assessment of post-transplant native renal function following CLKTx may allow for improved accuracy in identifying the patients in need of CLKTx, and thus allow for greater optimization of dual-organ allocation strategies in patients with concomitant liver and renal failure.

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“…Nevertheless, nowadays most of the data we can discuss on this specific topic are related to observations made in patients with type 1 HRS who did not receive treatment with vasoconstrictors and albumin. These data indicate that the percentage of patients who will recover renal function after LT ranges from 58% to 94% [34,35]. Several factors may contribute [35].…”

Section: Non-response To Treatment With Terlipressin and Albumin: Impmentioning

confidence: 91%

“…These data indicate that the percentage of patients who will recover renal function after LT ranges from 58% to 94% [34,35]. Several factors may contribute [35]. Although these observations are not specifically coming from non-responders to treatment with terlipressin and albumin, they suggest that if the time elapsed between the onset of type 1 HRS and LT is within 4 and 6 weeks, ARF is resolved in many of the patients by LT alone, regardless of whether or not they needed RRT in the pre-transplant setting.…”

Section: Non-response To Treatment With Terlipressin and Albumin: Impmentioning

confidence: 95%

Hepatorenal syndrome, MELD score and liver transplantation: An evolving issue with relevant implications for clinical practice

Angeli¹,

Ginès²

2012

Journal of Hepatology

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Hepatorenal syndrome (HRS) is a severe complication of cirrhosis that is associated with poor survival. A rapid diagnosis of HRS and a prompt initiation of the treatment with terlipressin and albumin are mandatory because this leads to an improvement of prognosis. This review covers the predictive value of HRS on 3-month mortality beyond the MELD score and its consequential impact on the prioritization policy to liver transplantation (LT). Moreover, it analyzes the impact of the response to pharmacological treatment on the MELD score, its possible delaying effect on the timing of LT, and suggests a way of overcoming the paradoxical effect of terlipressin and albumin on the priority to LT in responders. Finally, the review discusses the appropriate use of combined liver-kidney transplantation (CLKT) in patients with HRS who do not respond to treatment with terlipressin and albumin.

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Outcome of Patients With Hepatorenal Syndrome Type 1 After Liver Transplantation: Hangzhou Experience

Abstract: Patients developing HRS type 1 in the absence of high MELD score and low serum sodium would benefit from LT.

Cited by 37 publications

References 37 publications

Downgrading MELD Improves the Outcomes after Liver Transplantation in Patients with Acute-on-Chronic Hepatitis B Liver Failure

Downgrading MELD Improves the Outcomes after Liver Transplantation in Patients with Acute-on-Chronic Hepatitis B Liver Failure

Native renal function after combined liver-kidney transplant for type 1 hepatorenal syndrome: initial report on the use of postoperative Technetium-99 m-mercaptoacetyltriglycine scans

Hepatorenal syndrome, MELD score and liver transplantation: An evolving issue with relevant implications for clinical practice

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