title: Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1.
abstract: The development of hepatorenal syndrome type 1 (HRS1) is associated with a poor prognosis. Liver transplantation improves this prognosis, but the degree of the improvement is unclear. Most patients receive vasoconstrictors such as terlipressin before transplantation, and this may affect the posttransplant outcomes. We examined a cohort of patients with access to liver transplantation from our previously published study of terlipressin plus albumin versus albumin alone in the treatment of HRS1. The purpose of this analysis was the quantification of the survival benefits of liver transplantation for patients with HRS1. Ninety-nine patients were randomized to terlipressin or placebo. Thirty-five patients (35%) received a liver transplant. Among those receiving terlipressin plus albumin, the 180-day survival rates were 100% for transplant patients and 34% for nontransplant patients; among those receiving only albumin, the rates were 94% for transplant patients and 17% for nontransplant patients. The survival rate was significantly better for those achieving a reversal of hepatorenal syndrome (HRS) versus those not achieving a reversal (47% versus 4%, P < 0.001), but it was significantly lower for the responders versus those undergoing liver transplantation (97%). We conclude that the use of terlipressin plus albumin has no significant impact on posttransplant survival. Liver transplantation offers a clear survival benefit to HRS1 patients regardless of the therapy that they receive or the success or failure of HRS reversal. The most likely benefit of terlipressin in patients undergoing liver transplantation for HRS1 is improved pretransplant renal function, and this should make the posttransplant management of this difficult group of patients easier. For patients not undergoing transplantation, HRS reversal with terlipressin and/or albumin improves survival.
authors.affiliation: Liver Research Institute, Department of Internal Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA. tboyer@deptofmed.arizona.edu
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Boyer
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.forename: Frederick
authors.initials: F
authors.lastname: Regenstein
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rossaro
authors.forename: Beate
authors.initials: B
authors.lastname: Appenrodt
authors.forename: Veit
authors.initials: V
authors.lastname: Gülberg
authors.forename: Samuel
authors.initials: S
authors.lastname: Sigal
authors.forename: Alice S
authors.initials: AS
authors.lastname: Bexon
authors.forename: Peter
authors.initials: P
authors.lastname: Teuber
mesh_terms: D000418:Albumins / Q000627:therapeutic use; D015331:Cohort Studies; D006530:Hepatorenal Syndrome / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011379:Prognosis; D015996:Survival Rate; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin