Effect of the response to preoperative treatment for hepatorenal syndrome on the outcome of recipients of living‐donor liver transplantation

• Published in: Journal of Hepato-Biliary-Pancreatic Sciences Vol. 29; no. 7; pp. 798 - 809
• Main Authors: Takahashi, Ryugen, Akamatsu, Nobuhisa, Nakazawa, Akiko, Nagata, Rihito, Ichida, Akihiko, Kawaguchi, Yoshikuni, Ishizawa, Takeaki, Kaneko, Junichi, Arita, Junichi, Hasegawa, Kiyoshi
• Format: Journal Article
• Language: English
• Published: Japan Wiley 01.07.2022; Wiley Subscription Services, Inc
• Subjects: chronic kidney disease; Hepatorenal Syndrome; Humans; Liver Transplantation; Liver transplants; Living Donors; living‐donor liver transplantation; preoperative treatment; preserving renal function; Renal Insufficiency, Chronic; Retrospective Studies; Survival Rate; Treatment Outcome; chronic kidney disease; living-donor liver transplantation; preoperative treatment; hepatorenal syndrome; preserving renal function
• ISSN: 1868-6974; 1868-6982; 1868-6982
• DOI: 10.1002/jhbp.1143

Background The effect of pretransplant hepatorenal syndrome (HRS) on the outcomes of living‐donor liver transplantation (LDLT) recipients with special reference to the recovery of HRS before LDLT was investigated. Methods The rate of HRS was 43.9% (125/285) among the cohort, and the subjects were divided into three groups: those without HRS (No‐HRS group, n = 160), those with HRS but recovered following pretransplant renal function restoration treatment (Responders group, n = 55), and those with persistent HRS (Non‐responders group, n = 70). Results While the 1‐, 3‐, and 5‐year patient survival rates were comparable between those with and without HRS (89.6%, 84.7%, and 84.7% vs 95.6%, 92.2%, and 87.5%), the cumulative incidence of the development of posttransplant chronic kidney disease (CKD) was significantly higher in those with HRS (P < .001). In addition, there was a significant difference between Responders and Non‐responders in the development of CKD (P = .01). In the Cox regression model, Non‐responders (P = .032, HR 1.79 [95% C.I. 1.05‐3.03]) and recipient age (P = .014, HR 1.62 [95% C.I. 1.10‐2.37]) were independent predictors for the development of CKD after LDLT. Conclusion Living‐donor liver transplantation is safe and effective for patients with HRS, and CKD progression could be reduced among those with HRS who responded to renal restoration treatment. Takahashi and colleagues investigated posttransplant renal function in living‐donor liver transplantation recipients, focusing on pretransplant hepatorenal syndrome and the response to pretransplant treatment. Not only the presence of pretransplant hepatorenal syndrome but also the response to preoperative renal sparing therapy were associated with the development of posttransplant chronic kidney disease.