title: Pretransplant Type 2 Hepatorenal Syndrome Is Associated With Persistently Impaired Renal Function After Liver Transplantation.
abstract: BACKGROUND
  Type 2 hepatorenal syndrome (HRS2) is a functional renal impairment complicating end-stage liver disease. Although it is reversible after liver transplantation, long-term posttransplant outcomes in HRS2 patients remain ill-defined.
  
  
  METHODS
  Retrospective, matched case-control (1:2) study of all adult HRS2 patients transplanted in our institution between 2000 and 2012. The HRS2 patients were identified from our electronic transplant database, and matched with controls for the following variables: age, sex, etiology, diabetes mellitus, and year of transplant.
  
  
  RESULTS
  Forty-two HRS2 patients were compared to 83 controls. At the time of transplant, HRS2 patients had an estimated glomerular filtration rate of 41 ± 1 mL/min per 1.73 m. The HRS2 patients had greater intraoperative packed red blood cell transfusion (P = 0.002), and longer intensive care unit (P = 0.01) as well as total hospital length of stay (P = 0.03). Reversal of HRS2 occurred in 88.1% patients, 5.7 ± 0.5 days after transplantation. Although HRS2 patients had lower initial exposure to calcineurin inhibitors, a greater proportion of HRS2 patients had chronic kidney disease stage 3 (CKD3) at 3 (53.8% vs 28.4%; P = 0.007) and 12 months (59.5% vs 38.2%; P = 0.03) compared to controls. One-year survival was similar between the 2 groups (log-rank P = 0.82). On multivariate analysis, pretransplant HRS2 was associated with CKD3 at 3 (odds ratio, 3.73; 95% confidence interval, 1.54-9.03; P = 0.004) and 12 months (odds ratio, 3.23; 95% confidence interval, 1.37-7.64; P = 0.007) after transplantation.
  
  
  CONCLUSIONS
  Liver transplantation reverses HRS2 in the majority of patients with survival outcomes comparable to matched controls, despite longer stays in intensive care unit and in hospital. Pretransplant HRS2 is associated with early posttransplant CKD3, despite calcineurin-inhibitor minimization.
authors: 1 Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 2 Liver Transplant Program, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors: Hiang K
authors: HK
authors: Tan
authors: Max
authors: M
authors: Marquez
authors: Florence
authors: F
authors: Wong
authors: Eberhard L
authors: EL
authors: Renner
mesh_terms: D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017707:Erythrocyte Transfusion; D005260:Female; D005919:Glomerular Filtration Rate; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D020127:Recovery of Function; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents