Recovery from “Hepatorenal Syndrome” after Orthotopic Liver Transplantation

Iwatsuki, Shunzaburo; Popovtzer, Mordecai M.; Corman, J; Ishikawa, Makoto; Putnam, Charles W.; Katz, Fred H.; Starzl, Thomas E.

doi:10.1056/nejm197311292892201

Cited by 239 publications

(89 citation statements)

References 23 publications

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“…96,97 Investigations performed during the a progressive stimulation of the SNS and RAAS and the nonosmotic release of ADH, indicating the existence of 1960s and 1970s using clearance techniques and methods to evaluate the renal circulation showed that HRS a gradual impairment in the arterial circulation as one progresses from compensated to decompensated cirrhois associated with marked renal vasoconstriction. 98,99 In these studies, it was also shown that this renal vaso-sis and, finally, the HRS.…”

Section: M4533$0033mentioning

confidence: 99%

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

Arroyo¹,

Ginès²,

Gerbes³

et al. 1996

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During the last decade great advances have been made of water retention and dilutional hyponatremia in human cirrhosis. Finally, the field of spontaneous infection of concerning the pathogenesis and treatment of ascites. A new hypothesis on the mechanism of renal dysfunction ascitic fluid (spontaneous bacterial peritonitis) is also experiencing major changes. The demonstration of intestiand ascites formation in cirrhosis has been proposed 1 and this has greatly stimulated research in this area. The nal bacterial translocation in experimental models of cirrhosis, 12 the potential role of cytokines in some discovery of the important role played by the vascular endothelium in the homeostasis of systemic hemodynam-complications associated with this infection, 13 the identification of subgroups of cirrhotic patients predisposed to ics and renal function 2,3 has also opened an important field of research into pathophysiology, and evidence has develop spontaneous bacterial peritonitis, 14 and the effectiveness of selective intestinal decontamination in the been presented implicating endothelial factors in the pathogenesis of systemic circulatory dysfunction in cir-primary and secondary prophylaxis of spontaneous bacterial peritonitis 15,16 are the most relevant developments. rhosis 4,5 and hepatorenal syndrome (HRS). 6 The reintroduction of therapeutic paracentesis has greatly modifiedIn clear contrast to these advances, little attention has been paid to the standardization of the nomenclathe treatment of cirrhotic patients with tense or refractory ascites. 7 The transjugular intrahepatic portosys-ture and diagnostic criteria of different syndromes associated with ascites in cirrhosis. The existence of a temic shunt is another therapeutic tool of potential interest in the management of refractory ascites. 8 The uniform language, however, is essential in modern medicine. It facilitates communication among clinisynthesis of orally-active specific antagonists of the tubular effect of antidiuretic hormone and inhibitors of antidi-cians and researchers and ensures unambiguous diagnoses and more confident prognoses. Moreover, it uretic hormone release will probably add new drugs to the pharmacological armamentarium for patients with improves pathophysiological and therapeutic investigations, simplifies the analysis of therapeutic trials, cirrhosis and ascites. These ''aquaretic drugs,'' which normalize renal water metabolism in experimental cirrhosis and stimulates multicenter studies. and ascites, 9-11 are of potential interest for the treatment PREVIOUS CONSENSUS DEFINITIONS OF HEPATORENAL SYNDROME AND

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Section: M4533$0033mentioning

confidence: 99%

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

Arroyo¹,

Ginès²,

Gerbes³

et al. 1996

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“…For treating kidney disease, a number of treatment options exist, which vary based on the cause of the kidney injury. Orthotopic liver transplant (OLT) has been well described as a definitive treatment in some cases of HRS (4). Our understanding of why some patients with HRS recover renal function after OLT and why others do not is limited; however, some data suggest that duration of kidney injury prior to transplant is an important factor (5).…”

Section: Introductionmentioning

confidence: 99%

Renal recovery following orthotopic liver transplant after prolonged kidney injury: Perspectives on diagnosing hepatorenal syndrome and determining which patients should undergo simultaneous liver kidney transplantation

Card

Moeckel

Turner

2017

jrenhep

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We present a case of an individual with cirrhosis and renal failure. This case is notable because the patient was found to have hepatorenal syndrome (HRS) superimposed on Immunoglobulin A (IgA) nephropathy. After 8 months of dialysis, the patient had significant renal recovery following orthotopic liver transplant (OLT). Cases such as this are not likely to be rare, as case series have shown that IgA deposits are a common occurrence in patients with cirrhosis, including those who have HRS. While current diagnostic criteria for HRS emphasize the importance of excluding glomerular lesions, we argue that this approach should be reconsidered. More specifically, we feel that the diagnostic approach to HRS should be more inclusive of cases in which patients have simultaneous HRS and glomerular injury. In addition, our case highlights the challenges in determining which patients will benefit most from simultaneous liver-kidney transplants over OLTs alone.

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“…7 The functional nature of this renal insuffi ciency was emphasized by Koppel et al, 8 who proved in the 1960s that kidneys obtained from dead patients with HRS could be transplanted into patients with renal insufficiency of different etiology, since these kidneys could recover their functional capacity after the transplantation. In the 1970s, Iwatsuki et al 9 showed that HRS patients recovered renal function after orthotopic liver transplantation, thus further highlighting the functional Hepatorenal syndrome (HRS) is the development of renal failure in patients with chronic previous liver disease, without clinical or laboratory evidence of previous kidney disease. It affects up to 18% of cirrhotic patients with ascites during the fi rst year of follow-up, reaching 39% in fi ve years and presenting a survival of about two weeks after its establishment.…”

Section: Introductionmentioning

confidence: 99%

Hepatorenal syndrome: an update

Genzini

Torricelli

2007

Sao Paulo Med. J.

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RESUMO Síndrome hepatorrenal: estado atualA síndrome hepatorrenal (SHR) é o desenvolvimento do quadro de insufi ciência renal em pacientes com doença hepática crônica prévia sem evidências clínica ou laboratorial de nefropatia prévia. Atinge até 18% dos pacientes cirróticos com ascite em um ano, chegando a 39% em cinco anos, com uma sobrevida média em torno de duas semanas após estabelecido o quadro. O diagnóstico da SHR baseia-se em critérios clínicos e laboratoriais. Seu aparecimento está relacionado ao mecanismo de formação de ascite, que envolve vasoconstrição e hipofl uxo renal, retenção de água e sódio, aumento do volume plasmático, e conseqüentemente hiperfl uxo no território esplâncnico. Mediadores vasoativos renais e humorais, como a endotelina 1, tromboxano A2 e leucotrienos, estão ainda envolvidos na gênese desta síndrome que culmina com insufi ciência renal funcional. O tratamento preconizado da SHR pode ser farmacológico ou cirúrgico, sendo o transplante de fígado o único efetivo e permanente, com sobrevida de até 60% em quatro anos. Após melhora da função hepática, geralmente há a reversão da insufi ciência renal. O diagnóstico precoce e a rápida terapêutica podem ampliar a expectativa de vida destes hepatopatas enquanto se aguarda o transplante hepático para seu tratamento defi nitivo. PALAVRAS-CHAVE:

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Recovery from “Hepatorenal Syndrome” after Orthotopic Liver Transplantation

Cited by 239 publications

References 23 publications

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

Renal recovery following orthotopic liver transplant after prolonged kidney injury: Perspectives on diagnosing hepatorenal syndrome and determining which patients should undergo simultaneous liver kidney transplantation

Hepatorenal syndrome: an update

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