Ann Surg Treat Res.  2020 Feb;98(2):102-109. 10.4174/astr.2020.98.2.102.

Is renal replacement therapy necessary in deceased donor liver transplantation candidates with hepatorenal syndrome?: a 2-year experience at a high-volume center

Affiliations
  • 1Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr

Abstract

PURPOSE
Hepatorenal syndrome (HRS) is a fatal complication in patients with end-stage liver disease awaiting liver transplantation (LT). HRS often develops in patients with high model for end-stage liver disease (MELD) score. This study investigated the outcomes of peritransplant management of HRS in a high-volume LT center in Korea for 2 years.
METHODS
A total of 157 recipients that deceased donor liver transplantation (DDLT) from January 2017 to December 2018 were included. In-hospital mortality (IHM) was analyzed in relation to pre- and posttransplant application of renal replacement therapy (RRT).
RESULTS
Primary diagnoses for DDLT were alcoholic liver disease (n = 61), HBV-associated liver cirrhosis (n = 48), retransplantation for chronic graft failure (n = 24), and others (n = 24). Mean MELD score was 34.6 ± 6.2 with 72 patients at Korean Network for Organ Sharing MELD status 2 (45.9%), 43 at status 3 (27.4%), 36 at status 4 (22.9%), and 6 at status 5 (3.8%). Pretransplant RRT was performed in 16 patients (10.2%) that did not show IHM. Posttransplant RRT was performed in 69 patients (44.0%), for whom IHM incidence was 15.9%. In 53 patients that had undergone de novo posttransplant RRT, IHM incidence increased to 20.8%. IHM in the 88 patients not requiring RRT was 2.3%.
CONCLUSION
The majority of adult DDLT recipients in Korean MELD score-based allocation system have very high MELD scores, which is often associated with HRS. Pretransplant RRT appears to improve posttransplant survival outcomes. We thereby recommend that, if indicated, pretransplant RRT be performed while awaiting DDLT.

Keyword

Hemodialysis; Renal replacement therapy

MeSH Terms

Adult
Diagnosis
Hepatorenal Syndrome*
Hospital Mortality
Humans
Incidence
Korea
Liver Cirrhosis
Liver Diseases
Liver Diseases, Alcoholic
Liver Transplantation*
Liver*
Renal Dialysis
Renal Replacement Therapy*
Tissue Donors*
Transplants

Figure

  • Fig. 1 Distribution of model for end-stage liver disease (MELD) scores in 157 patients who underwent deceased donor liver transplantation.

  • Fig. 2 Sequential changes of end-stage liver disease (MELD) scores in 22 patients on the liver transplantation waiting list. Squares indicate deceased donor liver transplantation (DDLT); circles indicate waiting-list mortality; and triangles indicate patient mortality after waiting for more than 1 month. Multiple lines indicate patient number.

  • Fig. 3 Distribution of patients that underwent pretransplant renal replacement therapy (RRT), ventilator support, and posttransplant RRT.

  • Fig. 4 Comparison of posttransplant patient survival curves according to pretransplant renal replacement therapy (RRT).

  • Fig. 5 Comparison of in-hospital mortality (IHM) rates according to pre- and posttransplant renal replacement therapy (RRT).


Cited by  2 articles

Prognosis of Split Liver Transplantation Compared with Whole Liver Transplantation in Adult Patients: Single-center Results under the Korean MELD Score-based Allocation Policy
Gil-Chun Park, Shin Hwang, Gi-Won Song, Dong-Hwan Jung, Tae-Yong Ha, Chul-Soo Ahn, Deok-Bog Moon, Ki-Hun Kim, Young-In Yoon, Woo-Hyoung Kang, Hwui-Dong Cho, Jin Uk Choi, Minjae Kim, Byeong-Gon Na, Sang Hoon Kim, Sung-Gyu Lee
J Korean Med Sci. 2020;35(37):e304.    doi: 10.3346/jkms.2020.35.e304.

The impact of Model for End-Stage Liver Disease score on deceased donor liver transplant outcomes in low volume liver transplantation center: a retrospective and single-center study
Doo-Ho Lee, Yeon Ho Park, Seok Won Choi, Kug Hyun Nam, Sang Tae Choi, Doojin Kim
Ann Surg Treat Res. 2021;101(6):360-367.    doi: 10.4174/astr.2021.101.6.360.


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