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

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.

• Authors: Kenneth S H Chok, James Y Y Fung, See Ching Chan, Tan To Cheung, William W Sharr, Albert C Y Chan, Sheung Tat Fan, Chung Mau Lo
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 18 Issue 7 Pg. 779-85 (Jul 2012) ISSN: 1527-6473 [Electronic] United States
• PMID: 22290625 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 American Association for the Study of Liver Diseases.

Chemical References

• Albumins
• Immunosuppressive Agents
• Lypressin
• Terlipressin

Topics

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