title: Outcomes of living donor liver transplantation for patients with preoperative type 1 hepatorenal syndrome and acute hepatic decompensation.
abstract: This study investigated the outcomes of living donor liver transplantation (LDLT) for patients with preoperative type 1 hepatorenal syndrome (HRS) and acute hepatic decompensation. Prospectively collected data for 104 patients who had fulminant hepatic failure, acute decompensation of cirrhosis, or an acute flare of chronic hepatitis B were analyzed. Thirty-three patients (31.7%) had HRS (the HRS group), and 71 patients (68.3%) did not (the non-HRS group). The median follow-up period was 60 months. The HRS group had significantly more preoperative intensive care unit (ICU) admissions (84.8% versus 60.6%, P = 0.01), worse preoperative blood test results (creatinine, 248 versus 88 μmol/L, P < 0.001; total bilirubin, 630 versus 555 μmol/L, P = 0.001), more hemodialysis (48.5% versus 0%, P < 0.001), more blood transfusions (9 versus 4 U, P < 0.001), longer postoperative ICU stays (8 versus 4 days, P < 0.001), worse postoperative blood test results (creatinine at 1 year, 108 versus 96 μmol/L, P = 0.006), and poorer overall survival (P < 0.001). In a multivariate analysis, only HRS was associated with poorer overall survival (hazard ratio = 8.592, 95% confidence interval = 1.782-41.431, P = 0.007). In conclusion, HRS patients had worse postoperative renal function and overall survival than non-HRS patients. However, their 5-year overall survival rate was still nearly 80%, which is satisfactory. Therefore, LDLT can be considered for patients who have acute hepatic decompensation with or without HRS.
authors.affiliation: Department of Surgery, University of Hong Kong, Hong Kong, China. kennethchok@yahoo.com.hk
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: James Y Y
authors.initials: JY
authors.lastname: Fung
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.forename: William W
authors.initials: WW
authors.lastname: Sharr
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D000418:Albumins / Q000378:metabolism; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006530:Hepatorenal Syndrome / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008107:Liver Diseases / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008236:Lypressin / Q000031:analogs & derivatives / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D000077585:Terlipressin; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D007166:Immunosuppressive Agents; D008236:Lypressin; D000077585:Terlipressin