Management and outcome in hepatorenal syndrome: need for renal replacement therapy in non-transplanted patients.
OBJECTIVE
Hepatorenal syndrome (HRS) type I is a devastating complication of decompensated cirrhosis. Liver transplantation (LT) offers an excellent survival, and renal replacement therapy (RRT) may be useful until transplantation is available. The survival benefit of RRT in the absence of LT is thought to be short and its benefit in these patients is unknown. To investigate this, we studied the outcome of different therapies (pharmacological, RRT, and LT) in patients with type 1 HRS.


METHODS
Medical records (2005-2009) of all cirrhotic patients admitted to our facility with abnormal renal function were reviewed. Patients with preexisting renal disease, diagnosis other than type I HRS, or those without long-term follow-up were excluded.


RESULTS
Of 380 patients reviewed, 30 were studied. Nineteen (63.3 %) patients underwent liver transplantation. No difference in baseline liver or renal parameters was noted between those who were or were not transplanted. A decreased mortality was noted (5.3 vs. 64.6 %; p = 0.0005) compared to patients who were not transplanted during the study follow-up median period of 7.8 [CI 1.9-34] months. Among non-transplanted patients, no differences in median survival (8.8 vs. 6.5 months; p = 0.62) or in other parameters studied were found in those patients who received RRT compared to those who did not. Similarly, no survival difference was found comparing those who did or did not receive pharmacological therapy without transplant.


CONCLUSIONS
In type I HRS, LT offers better survival. Among patients who do not receive LT, RRT does not provide an improved survival benefit.
Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, souria@upmc.edu.
Achuthan
A
Sourianarayanane
Rupesh
R
Raina
Gaurav
G
Garg
Arthur J
AJ
McCullough
Robert S
RS
O'Shea
D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006530:Hepatorenal Syndrome / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000418:Albumins; D005765:Gastrointestinal Agents; D014662:Vasoconstrictor Agents; D008879:Midodrine; D015282:Octreotide