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The course of type 1 hepato-renal syndrome post liver transplantation

Marik, PE and Wood, K and Starzl, TE (2006) The course of type 1 hepato-renal syndrome post liver transplantation. Nephrology Dialysis Transplantation, 21 (2). 478 - 482. ISSN 0931-0509

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Background. Hepato-renal syndrome (HRS) is a functional form of renal failure that occurs in patients with end-stage liver disease. Previously considered fatal without liver transplantation, treatment with vasoconstrictors and albumin has been demonstrated to improve renal function in patients with type 1 HRS. Liver transplantation is still considered the definitive treatment for HRS. However, the renal recovery rate and those factors that predict recovery post orthotopic liver transplantation have not been determined. Methods. We reviewed the hospital course of 28 patients who met the International Ascites Club criteria for type I HRS and who underwent orthotopic liver transplant. The patients' demographic and pre- and post-operative laboratory data were recorded; patients were followed for 4 months post-transplantation or until death. Results. The MELD score of the patients was 30±6. The mean duration of HRS prior to liver transplantation was 37±27 days. HRS resolved in 16 patients (58%). The mean time to resolution of HRS was 21±27 days, with a range of 4-110 days. Eight (50%) patients in whom the HRS resolved were undergoing pre-transplantation dialysis. The age of the recipients (49±10 vs 56±12; P = 0.05), the total bilirubin level on post-operative day 7 (6.0±4.3 vs 10.1±5.9mg/dl; P = 0.04), alcoholic liver disease and the requirement for post-transplant dialysis were predictors of resolution of HRS by univariate analysis. Only alcoholic liver disease and post-transplant dialysis were independent (negative) predictors of resolution of HRS. Seven of the 12 (58%) patients who developed chronic renal insufficiency remained dialysis dependent. The pre-operative serum creatinine was non-significantly higher in the non-resolvers who remained dialysis dependent compared to those who did not require long-term dialysis (3.0±1.0 vs 2.3±0.4 mg/dl; P = 0.1) Four patients died; in three of these patients the HRS had resolved prior to their death. Conclusion. HRS is not always cured by orthotopic liver transplant. Pre-transplantation dialysis or a long waiting period should not preclude transplantation in patients with HRS. HRS may not resolve in patients with alcoholic liver disease. We were unable to accurately define that group of patients with HRS who required long-term dialysis and could theoretically benefit from combined liver-kidney transplantation. © The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Marik, PE
Wood, K
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 February 2006
Date Type: Publication
Journal or Publication Title: Nephrology Dialysis Transplantation
Volume: 21
Number: 2
Page Range: 478 - 482
DOI or Unique Handle: 10.1093/ndt/gfi212
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0931-0509
Article Type: Review
Other ID: uls-drl:31735062121326, Starzl CV No. 2220
Date Deposited: 08 Apr 2010 17:38
Last Modified: 02 Feb 2019 13:58


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