title: Liver transplant outcomes for patients with hepatorenal syndrome treated with pretransplant vasoconstrictors and albumin.
abstract: BACKGROUND
  The combination of octreotide, midodrine, and albumin (triple therapy) is used to treat hepatorenal syndrome (HRS) often as a bridge to liver transplantation (LT). We examined post-LT outcomes in recipients with HRS, including the effect of pre-LT triple therapy.
  
  
  METHODS
  Patients with HRS treated with triple therapy (cases) pre-LT were compared with a cohort that underwent LT in the immediate era before triple therapy was used (controls).
  
  
  RESULTS
  Forty-three patients with HRS underwent LT (27 cases and 16 controls). Twenty-one patients (49%) required hemodialysis (HD) pre-LT (48% of cases vs. 50% of controls, P=1.00). After LT, mean glomerular filtration rate (GFR) was similar between cases and controls at 1 month (56.9 vs. 52.6 mL/min/1.73 m(2), P=0.61) and at 1 year (P=0.13). Of the 27 cases, 11 responded to triple therapy pre-LT. Compared with nonresponders, there was no difference in GFR at 1 month (57.2 vs. 56.6 mL/min/1.73 m, P=0.96) or 1 year (P=0.48) post-LT. Long-term HD after LT was required in 7.7% of cases and 12.5% of controls (P=0.61).
  
  
  CONCLUSIONS
  LT alone improved renal function in most patients with HRS, including those requiring short-term HD. Pre-LT treatment of HRS with triple therapy was not associated with additional benefit in GFR after LT.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Rice
authors.forename: Catherine
authors.initials: C
authors.lastname: Skagen
authors.forename: Adnan
authors.initials: A
authors.lastname: Said
mesh_terms: D000328:Adult; D000418:Albumins / Q000627:therapeutic use*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D015282:Octreotide / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014850:Waiting Lists; D014922:Wisconsin
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents; D008879:Midodrine; D015282:Octreotide