TY - JOUR
T1 - Long-term renal outcomes comparison between patients with chronic kidney disease and hepatorenal syndrome after living donor liver transplantation
AU - Tseng, Hsiang Yu
AU - Lin, Yu Hung
AU - Lin, Chih Che
AU - Chen, Chao Long
AU - Yong, Chee Chien
AU - Lin, Li Man
AU - Wang, Chih Chi
AU - Chan, Yi Chia
N1 - © 2023 Tseng, Lin, Lin, Chen, Yong, Lin, Wang and Chan.
PY - 2023
Y1 - 2023
N2 - BACKGROUND AND AIMS: Hepatorenal syndrome (HRS) is a disastrous renal complication of advanced liver disease with a poor prognosis. Restoring normal liver function through liver transplantation (LT) is a standardized treatment with favorable short-term survival. However, the long-term renal outcomes in patients with HRS receiving living donor LT (LDLT) are controversial. This study aimed to investigate the prognostic impact of LDLT in patients with HRS.METHODS: We reviewed adult patients who underwent LDLT between July 2008 and September 2017. Recipients were classified into 1) HRS type 1 (HRS1,
N = 11), 2) HRS type 2 (HRS2,
N = 19), 3) non-HRS recipients with pre-existing chronic kidney disease (CKD,
N = 43), and 4) matched normal renal function (
N = 67).
RESULTS: Postoperative complications and 30-day surgical mortality were comparable among the HRS1, HRS2, CKD, and normal renal function groups. The 5-year survival rate was >90% and estimated glomerular filtration rate (eGFR) transiently improved and peaked at 4 weeks post-transplantation in patients with HRS. However, renal function deteriorated and resulted in CKD stage ≥ III in 72.7% of HRS1 and 78.9% of HRS2 patients (eGFR <60 ml/min/1.73 m
2). The incidence of developing CKD and end-stage renal disease (ESRD) was similar between the HRS1, HRS2, and CKD groups, but significantly higher than that in the normal renal function group (both
P < 0.001). In multivariate logistic regression, pre-LDLT eGFR <46.4 ml/min/1.73 m
2 predicted the development of post-LDLT CKD stage ≥ III in patients with HRS (AUC = 0.807, 95% CI = 0.617-0.997,
P = 0.011).
CONCLUSIONS: LDLT provides a significant survival benefit for patients with HRS. However, the risk of CKD stage ≥ III and ESRD among patients with HRS was similar to that in pre-transplant CKD recipients. An early preventative renal-sparing strategy in patients with HRS is recommended.
AB - BACKGROUND AND AIMS: Hepatorenal syndrome (HRS) is a disastrous renal complication of advanced liver disease with a poor prognosis. Restoring normal liver function through liver transplantation (LT) is a standardized treatment with favorable short-term survival. However, the long-term renal outcomes in patients with HRS receiving living donor LT (LDLT) are controversial. This study aimed to investigate the prognostic impact of LDLT in patients with HRS.METHODS: We reviewed adult patients who underwent LDLT between July 2008 and September 2017. Recipients were classified into 1) HRS type 1 (HRS1,
N = 11), 2) HRS type 2 (HRS2,
N = 19), 3) non-HRS recipients with pre-existing chronic kidney disease (CKD,
N = 43), and 4) matched normal renal function (
N = 67).
RESULTS: Postoperative complications and 30-day surgical mortality were comparable among the HRS1, HRS2, CKD, and normal renal function groups. The 5-year survival rate was >90% and estimated glomerular filtration rate (eGFR) transiently improved and peaked at 4 weeks post-transplantation in patients with HRS. However, renal function deteriorated and resulted in CKD stage ≥ III in 72.7% of HRS1 and 78.9% of HRS2 patients (eGFR <60 ml/min/1.73 m
2). The incidence of developing CKD and end-stage renal disease (ESRD) was similar between the HRS1, HRS2, and CKD groups, but significantly higher than that in the normal renal function group (both
P < 0.001). In multivariate logistic regression, pre-LDLT eGFR <46.4 ml/min/1.73 m
2 predicted the development of post-LDLT CKD stage ≥ III in patients with HRS (AUC = 0.807, 95% CI = 0.617-0.997,
P = 0.011).
CONCLUSIONS: LDLT provides a significant survival benefit for patients with HRS. However, the risk of CKD stage ≥ III and ESRD among patients with HRS was similar to that in pre-transplant CKD recipients. An early preventative renal-sparing strategy in patients with HRS is recommended.
KW - chronic kidney disease (CKD)
KW - end-stage liver disease (ESRD)
KW - hepatorenal syndrome (HRS)
KW - liver transplantation (LT)
KW - living donor LT (LDLT)
UR - https://www.scopus.com/pages/publications/85153523297
U2 - 10.3389/fsurg.2023.1116728
DO - 10.3389/fsurg.2023.1116728
M3 - 文章
C2 - 37077866
AN - SCOPUS:85153523297
SN - 2296-875X
VL - 10
SP - 1116728
JO - Frontiers in Surgery
JF - Frontiers in Surgery
M1 - 1116728
ER -
