BACKGROUND: Patients with hepatorenal syndrome (HRS) type 1 have an extremely poor prognosis. Liver transplantation (LT) is the only treatment that can cure terminal stage liver disease and reverse HRS. However, the data showing the impact of LT on patients with HRS type 1 are limited. METHODS: The outcome and prognostic factors of 32 patients with HRS type 1 receiving LT were investigated. The natural course of renal recovery and the efficacy of continuous post-LT veno-veno hemodialysis (CVVH) were also evaluated. RESULTS: Overall patient mortality was 34.4% (11/32), with eight patients died during the first month after LT. Scoring model was based on independent prognostic factors for the model end-stage liver diseases (MELD) (risk ratio=1.169) and serum sodium (risk ratio=0.769). High MELD score (>36) or low serum sodium (< or =126 mEq/L) or both were associated with reduced patient survival. HRS was resolved in 30 patients (median time, 24 days). Eight patients received post-LT CVVH. The need for CVVH was associated with higher pretransplant serum creatinine, longer duration of HRS, more pretransplant CVVH, more intraoperative blood products infusion, lower intraoperative urine output, and higher serum creatinine at 1 week posttransplant. However, serum creatinine at 1 month posttransplant and patient survival did not differ significantly between patients with and without CVVH. CONCLUSION: Patients developing HRS type 1 in the absence of high MELD score and low serum sodium would benefit from LT.
BACKGROUND:Patients with hepatorenal syndrome (HRS) type 1 have an extremely poor prognosis. Liver transplantation (LT) is the only treatment that can cure terminal stage liver disease and reverse HRS. However, the data showing the impact of LT on patients with HRS type 1 are limited. METHODS: The outcome and prognostic factors of 32 patients with HRS type 1 receiving LT were investigated. The natural course of renal recovery and the efficacy of continuous post-LT veno-veno hemodialysis (CVVH) were also evaluated. RESULTS: Overall patient mortality was 34.4% (11/32), with eight patients died during the first month after LT. Scoring model was based on independent prognostic factors for the model end-stage liver diseases (MELD) (risk ratio=1.169) and serum sodium (risk ratio=0.769). High MELD score (>36) or low serum sodium (< or =126 mEq/L) or both were associated with reduced patient survival. HRS was resolved in 30 patients (median time, 24 days). Eight patients received post-LT CVVH. The need for CVVH was associated with higher pretransplant serum creatinine, longer duration of HRS, more pretransplant CVVH, more intraoperative blood products infusion, lower intraoperative urine output, and higher serum creatinine at 1 week posttransplant. However, serum creatinine at 1 month posttransplant and patient survival did not differ significantly between patients with and without CVVH. CONCLUSION:Patients developing HRS type 1 in the absence of high MELD score and low serum sodium would benefit from LT.
Authors: Thomas D Boyer; Arun J Sanyal; Guadalupe Garcia-Tsao; Frederick Regenstein; Lorenzo Rossaro; Beate Appenrodt; Veit Gülberg; Samuel Sigal; Alice S Bexon; Peter Teuber Journal: Liver Transpl Date: 2011-11 Impact factor: 5.799
Authors: Riyaz U Saif; Hilal Ahmad Dar; Sozia Mohammad Sofi; Mushtaq Saif Andrabi; Gul Javid; Showkat Ali Zargar Journal: Indian J Gastroenterol Date: 2018-09-03
Authors: Juan P Arab; Juan C Claro; Juan P Arancibia; Jorge Contreras; Fernando Gómez; Cristian Muñoz; Leyla Nazal; Eric Roessler; Rodrigo Wolff; Marco Arrese; Carlos Benítez Journal: World J Hepatol Date: 2016-09-08
Authors: Carina Mari Aparici; Sukhkarn N Bains; David Carlson; Jesse Qian; Douglas Liou; David Wojciechowski; Jacob Werner; Sana Khan; Cameron Kroll; Manreet Sandhu; Nhan Nguyen; Randall Hawkins Journal: World J Nucl Med Date: 2016 Jan-Apr