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Title: Outcomes of patients with hepatorenal syndrome undergoing liver transplantation in the era of terlipressin.
Austin Authors: Terbah, Ryma ;Cao, Janet;Wong, Darren;Lim, Peter Chee Hau;Gow, Paul J ;Testro, Adam G ;Sinclair, Marie 
Affiliation: Gastroenterology and Hepatology
Victorian Liver Transplant Unit
Department of Medicine, University of Melbourne, Parkville, Australia.
Issue Date: 1-Aug-2023
Date: 2023
Publication information: European Journal of Gastroenterology & Hepatology 2023-08-01; 35(8)
Abstract: The efficacy of terlipressin in improving pre-liver transplant renal function in hepatorenal syndrome (HRS) has been well documented, however, its impact on post-transplant renal function remains poorly described. This study aims to describe the impact of HRS and terlipressin on post-liver transplant renal function and survival. A single-centre, retrospective, observational study was conducted to identify post-transplant outcomes of patients diagnosed with HRS undergoing liver transplant (HRS cohort) and those undergoing transplant for non-HRS, non-hepatocellular carcinoma cirrhotic indications (comparator cohort) between January 1997 and March 2020. The primary outcome was serum creatinine at 180 days post-liver transplant. Other renal outcomes and overall survival were secondary outcomes. 109 patients with HRS and 502 comparator patients underwent liver transplant. The comparator cohort was younger than the HRS cohort (53 vs. 57 years, P < 0.001). The median creatinine at day 180 post-transplant was higher in the HRS transplant group (119 µmol/L vs. 103 µmol/L, P < 0.001), however, this association lost significance following multivariate analysis. Seven patients (7%) in the HRS cohort received a combined liver-kidney transplant. There was no significant difference in the 12-month post-transplant survival between the two groups (94% vs. 94%, P = 0.5). Patients with HRS treated with terlipressin who subsequently undergo liver transplantation have post-transplant renal and survival outcomes comparable to patients transplanted for cirrhosis without HRS. This study supports the practice of liver-only transplant in this cohort and the reservation of renal allografts for those who have primary renal disease.
DOI: 10.1097/MEG.0000000000002584
Journal: European Journal of Gastroenterology & Hepatology
Start page: 881
End page: 888
PubMed URL: 37395241
ISSN: 1473-5687
Type: Journal Article
Subjects: Terlipressin/adverse effects
Hepatorenal Syndrome/diagnosis
Hepatorenal Syndrome/drug therapy
Hepatorenal Syndrome/surgery
Liver Transplantation/adverse effects
Lypressin/adverse effects
Vasoconstrictor Agents/therapeutic use
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