Outcome of patients with hepatorenal syndrome type 1 after liver transplantation: Hangzhou experience.

BACKGROUND: Patients with hepatorenal syndrome (HRS) type 1 have an extremely poor prognosis. Liver transplantation (LT) is the only treatment that can cure terminal stage liver disease and reverse HRS. However, the data showing the impact of LT on patients with HRS type 1 are limited.

METHODS: The outcome and prognostic factors of 32 patients with HRS type 1 receiving LT were investigated. The natural course of renal recovery and the efficacy of continuous post-LT veno-veno hemodialysis (CVVH) were also evaluated.

RESULTS: Overall patient mortality was 34.4% (11/32), with eight patients died during the first month after LT. Scoring model was based on independent prognostic factors for the model end-stage liver diseases (MELD) (risk ratio=1.169) and serum sodium (risk ratio=0.769). High MELD score (>36) or low serum sodium (< or =126 mEq/L) or both were associated with reduced patient survival. HRS was resolved in 30 patients (median time, 24 days). Eight patients received post-LT CVVH. The need for CVVH was associated with higher pretransplant serum creatinine, longer duration of HRS, more pretransplant CVVH, more intraoperative blood products infusion, lower intraoperative urine output, and higher serum creatinine at 1 week posttransplant. However, serum creatinine at 1 month posttransplant and patient survival did not differ significantly between patients with and without CVVH.

CONCLUSION: Patients developing HRS type 1 in the absence of high MELD score and low serum sodium would benefit from LT.