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

Abstract 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.