Patients with Pre-Operative Hepatorenal Syndrome (HRS) Have Poorer Long-Term Survival Outcome after Living Donor Liver Transplantation (LDLT)

Abstract

Background: The aim of this retrospective review is to investigate whether patients with and without pre-operative hepatorenal syndrome (HRS) have comparable long-term survival outcome after live donor liver transplantation (LDLT). Methods: Patients who had LDLT done from July 1994 to December 2007 were included in the analysis. The median follow-up period was 55 months. First 50 cases and patients with HCC were excluded from analysis. Results: Total of 177 patients was included in which 34 of them (19.2%) had pre-operative HRS. Signifi cantly more patients with pre-operative HRS, compared to those without, had worse pre-operative liver function test, more pre-operative ICU admission (p<0.001) and early post-operative complications (p<0.001). Signifi cantly more patients with pre-operative type I HRS died during hospital stay (5 vs. 2; p=0.001). Intra-operative blood transfusion was signifi cantly higher (9 units vs. 4 units; p<0.001) and median day of stay in Intensive Care Unit (ICU) was signifi cantly longer in patients with type I HRS (8.5 days vs. 4 days, p=<0.001). The renal function test was signifi cantly worse in patients with pre-operative type I HRS at postoperative one year (Cr 108umol/L vs. Cr 100umol/L; p=0.004) but was comparable at postoperative fi ve year (Cr 101umol/L vs. Cr 88umol/L; p=0.145). There was signifi cantly worse overall survival in patients with pre-operative HRS (log-rank test, p= 0.000). Conclusion: Patients with type I HRS had more early post-operative complications and hospital mortality. They also had poorer long-term overall survival when compared to those without preoperative HRS.