Hepatorenal syndrome: combined liver kidney transplants versus isolated liver transplant.
BACKGROUND
As many as 38% of combined liver-kidney transplant (LKTx) procedures performed nationally may be done for the renal diagnosis of hepatorenal syndrome (HRS). This study was designed to compare the national results with those at our medical center and to determine if combined LKTx provides any benefit over isolated liver transplant (LTx) to HRS patients.


METHODS
Data on 29 combined LKTx and 79 HRS patients at our center were collected and compared with the national data on 414 LKTx and 2442 patients with serum creatinine >2.0 mg/dl receiving isolated LTx from 1988 to 1995.


RESULTS
United Network of Organ Sharing data revealed 5-year patient survival of 62.2% for LKTx recipients and 50.4% for patients with serum creatinine >2.0 mg/dl receiving isolated LTx (P=0.0001). Our center results demonstrated 5-year patient survival of 48.1% for LKTx patients, 67.1% for HRS patients receiving isolated LTx, and 70.1% for patients with serum creatinine >2.0 mg/dl receiving isolated LTx (P not significant comparing all groups). Intensive care unit status and preoperative dialysis rates were similar in those HRS patients who did and those who did not need future KTx.


CONCLUSIONS
National data would suggest a survival benefit of combined LKTx over isolated LTx for those patients with poor renal function, specifically those with HRS, whereas our center's results suggest otherwise. Unfortunately, we could not identify any preoperative risk factors in the HRS patients, or in the broader group of patients with renal insufficiency at our center, that would indicate the need for future renal transplantation. We believe that HRS patients can be successfully managed with isolated LTx.
Jeyarajah
D R
DR
Transplantation Services, Baylor University Medical Center, Dallas, Texas 75246, USA.
Gonwa
T A
TA
McBride
M
M
Testa
G
G
Abbasoglu
O
O
Husberg
B S
BS
Levy
M F
MF
Goldstein
R M
RM
Klintmalm
G B
GB
D006530:Hepatorenal Syndrome / Q000601:surgery*; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D016019:Survival Analysis