Clinical outcomes of patients with hepatorenal syndrome after living donor liver transplantation.
Liver transplantation (LT) is the treatment of choice for hepatorenal syndrome (HRS). However, the clinical benefits of living donor liver transplantation (LDLT) are not yet well established. We, therefore, investigated the outcomes of patients with HRS who underwent LDLT and patients with HRS who received transplants from deceased donors. This study focused on 71 patients with HRS out of a total of 726 consecutive adult Korean patients who underwent LT at a single Asian center. We compared 48 patients who underwent LDLT with 23 patients who underwent deceased donor liver transplantation (DDLT). Patients with HRS showed poorer survival than patients without HRS (P = 0.01). Poorer survival was associated with higher in-hospital mortality for patients with HRS (18.3% versus 5.2%, P < 0.001). In comparison with DDLT, LDLT was associated with younger donors and shorter ischemic times. The survival rate with LDLT was significantly higher than the survival rate with DDLT (P = 0.02). Among patients with high Model for End-Stage Liver Disease scores (≥30) or type 1 HRS, the survival rates for the LDLT group were not inferior to those for the DDLT group. LDLT significantly improved recipient survival after adjustments for several risk factors (hazard ratio = 0.20, 95% confidence interval = 0.05-0.85, P = 0.03). Kidney function was significantly improved after LT, and there was no difference between LDLT and DDLT. No patients in the HRS cohort required maintenance renal replacement therapy. In conclusion, LDLT may be a beneficial option for patients with HRS.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Jung Pyo
JP
Lee
Hyuk Yong
HY
Kwon
Ji In
JI
Park
Nam-Joon
NJ
Yi
Kyung-Suk
KS
Suh
Hae Won
HW
Lee
Myounghee
M
Kim
Yun Kyu
YK
Oh
Chun Soo
CS
Lim
Yon Su
YS
Kim
D000328:Adult; D005260:Female; D006530:Hepatorenal Syndrome / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome