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


OBJECTIVE
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.
Restuccia
Tea
T
Liver Unit, Institute for Digestive Diseases, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona 08036, Catalunya, Spain.
Ortega
Rolando
R
Guevara
Monica
M
Ginès
Pere
P
Alessandria
Carlo
C
Ozdogan
Osman
O
Navasa
Miquel
M
Rimola
Antoni
A
Garcia-Valdecasas
Juan Carlos
JC
Arroyo
Vicente
V
Rodés
Juan
J
D016022:Case-Control Studies; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009951:Ornipressin / Q000627:therapeutic use; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D016019:Survival Analysis; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D009951:Ornipressin; D008236:Lypressin; D000077585:Terlipressin