Effect of the response to preoperative treatment for hepatorenal syndrome on the outcome of recipients of living‐donor liver transplantation. (5th April 2022) - Takahashi, Ryugen
Abstract: 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. Abstract : 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.