Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome.: A case-control study

Background: Pretransplant renal function is the major determinant of survival after liver transplantation (LTx). Patients with hepatorenal syndrome (HRS) have a poor outcome after LTx compared with patients transplanted without HRS. Aim: To analyze the impact of treatment of HRS before LTx on outcome after transplantation. Methods: The outcome of patients with HRS (n = 9) treated with vasopressin analogues before LTx was compared with that of a contemporary control group of patients without HRS (n = 27) matched by age, severity of liver failure, and type of immunosuppression. Results: Cases and controls were similar with respect to pretransplantation characteristics. Three-year survival probability was similar between the two groups (HRS-treated: 100% vs control: 83%, P = 0.15). No significant differences were found between the two groups with respect to the incidence of impairment of renal function after LTx (HRS-treated: 22% vs control: 30%), severe infections (22 vs 33%), acute rejection (33 vs 41%), days in Intensive Care Unit (6 +/- 1 vs 8 +/- 1), days in hospital (27 +/- 4 vs 31 +/- 4), and transfusion requirements (11 +/- 3 vs 10 +/- 2 units). Conclusions: Patients with HRS treated with vasopressin analogues before LTx have a posttransplantion outcome similar to that of patients transplanted with normal renal function. These results suggest that HRS should be treated before LTx. (C) 2003 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.