Outcomes of living donor liver transplantation for patients with preoperative type 1 hepatorenal syndrome and acute hepatic decompensation

Liver Transpl. 2012 Jul;18(7):779-85. doi: 10.1002/lt.23401.

Abstract

This study investigated the outcomes of living donor liver transplantation (LDLT) for patients with preoperative type 1 hepatorenal syndrome (HRS) and acute hepatic decompensation. Prospectively collected data for 104 patients who had fulminant hepatic failure, acute decompensation of cirrhosis, or an acute flare of chronic hepatitis B were analyzed. Thirty-three patients (31.7%) had HRS (the HRS group), and 71 patients (68.3%) did not (the non-HRS group). The median follow-up period was 60 months. The HRS group had significantly more preoperative intensive care unit (ICU) admissions (84.8% versus 60.6%, P = 0.01), worse preoperative blood test results (creatinine, 248 versus 88 μmol/L, P < 0.001; total bilirubin, 630 versus 555 μmol/L, P = 0.001), more hemodialysis (48.5% versus 0%, P < 0.001), more blood transfusions (9 versus 4 U, P < 0.001), longer postoperative ICU stays (8 versus 4 days, P < 0.001), worse postoperative blood test results (creatinine at 1 year, 108 versus 96 μmol/L, P = 0.006), and poorer overall survival (P < 0.001). In a multivariate analysis, only HRS was associated with poorer overall survival (hazard ratio = 8.592, 95% confidence interval = 1.782-41.431, P = 0.007). In conclusion, HRS patients had worse postoperative renal function and overall survival than non-HRS patients. However, their 5-year overall survival rate was still nearly 80%, which is satisfactory. Therefore, LDLT can be considered for patients who have acute hepatic decompensation with or without HRS.

MeSH terms

  • Adult
  • Albumins / metabolism
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Hepatorenal Syndrome / physiopathology
  • Hepatorenal Syndrome / therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Liver Diseases / physiopathology
  • Liver Diseases / therapy*
  • Liver Transplantation / methods*
  • Living Donors*
  • Lypressin / analogs & derivatives
  • Lypressin / chemistry
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • Renal Dialysis
  • Risk Factors
  • Terlipressin
  • Treatment Outcome

Substances

  • Albumins
  • Immunosuppressive Agents
  • Lypressin
  • Terlipressin