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

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.
(© 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)