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Outcomes of living donor liver transplantation for patients with preoperative type 1 hepatorenal syndrome and acute hepatic decompensation
Author(s) -
Chok Kenneth S. H.,
Fung James Y. Y.,
Chan See Ching,
Cheung Tan To,
Sharr William W.,
Chan Albert C. Y.,
Fan Sheung Tat,
Lo Chung Mau
Publication year - 2012
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23401
Subject(s) - medicine , hepatorenal syndrome , decompensation , hazard ratio , gastroenterology , creatinine , liver transplantation , intensive care unit , cirrhosis , prothrombin time , renal function , transplantation , surgery , confidence interval
This study investigated the outcomes of living donor liver transplantation (LDLT) for patients with preoperative type 1 hepatorenal syndrome (HRS) and acute hepatic decompensation. Prospectively collected data for 104 patients who had fulminant hepatic failure, acute decompensation of cirrhosis, or an acute flare of chronic hepatitis B were analyzed. Thirty‐three patients (31.7%) had HRS (the HRS group), and 71 patients (68.3%) did not (the non‐HRS group). The median follow‐up period was 60 months. The HRS group had significantly more preoperative intensive care unit (ICU) admissions (84.8% versus 60.6%, P = 0.01), worse preoperative blood test results (creatinine, 248 versus 88 μmol/L, P < 0.001; total bilirubin, 630 versus 555 μmol/L, P = 0.001), more hemodialysis (48.5% versus 0%, P < 0.001), more blood transfusions (9 versus 4 U, P < 0.001), longer postoperative ICU stays (8 versus 4 days, P < 0.001), worse postoperative blood test results (creatinine at 1 year, 108 versus 96 μmol/L, P = 0.006), and poorer overall survival ( P < 0.001). In a multivariate analysis, only HRS was associated with poorer overall survival (hazard ratio = 8.592, 95% confidence interval = 1.782‐41.431, P = 0.007). In conclusion, HRS patients had worse postoperative renal function and overall survival than non‐HRS patients. However, their 5‐year overall survival rate was still nearly 80%, which is satisfactory. Therefore, LDLT can be considered for patients who have acute hepatic decompensation with or without HRS. Liver Transpl, 2012. © 2012 AASLD.