Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case-control study

J Hepatol. 2004 Jan;40(1):140-6. doi: 10.1016/j.jhep.2003.09.019.

Abstract

Background: Pretransplant renal function is the major determinant of survival after liver transplantation (LTx). Patients with hepatorenal syndrome (HRS) have a poor outcome after LTx compared with patients transplanted without HRS.

Aim: To analyze the impact of treatment of HRS before LTx on outcome after transplantation.

Methods: The outcome of patients with HRS (n=9) treated with vasopressin analogues before LTx was compared with that of a contemporary control group of patients without HRS (n=27) matched by age, severity of liver failure, and type of immunosuppression.

Results: Cases and controls were similar with respect to pretransplantation characteristics. Three-year survival probability was similar between the two groups (HRS-treated: 100% vs control: 83%, P=0.15). No significant differences were found between the two groups with respect to the incidence of impairment of renal function after LTx (HRS-treated: 22% vs control: 30%), severe infections (22 vs 33%), acute rejection (33 vs 41%), days in Intensive Care Unit (6+/-1 vs 8+/-1), days in hospital (27+/-4 vs 31+/-4), and transfusion requirements (11+/-3 vs 10+/-2 units).

Conclusions: Patients with HRS treated with vasopressin analogues before LTx have a posttransplantation outcome similar to that of patients transplanted with normal renal function. These results suggest that HRS should be treated before LTx.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case-Control Studies
  • Female
  • Hepatorenal Syndrome / drug therapy*
  • Hepatorenal Syndrome / physiopathology
  • Hepatorenal Syndrome / surgery*
  • Humans
  • Kidney / physiopathology
  • Liver Failure / surgery
  • Liver Transplantation*
  • Lypressin / analogs & derivatives*
  • Lypressin / therapeutic use
  • Male
  • Middle Aged
  • Ornipressin / therapeutic use
  • Postoperative Complications
  • Postoperative Period
  • Prognosis
  • Survival Analysis
  • Terlipressin
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use
  • Vasopressins / therapeutic use*

Substances

  • Vasoconstrictor Agents
  • Vasopressins
  • Ornipressin
  • Lypressin
  • Terlipressin