Spontaneous Recovery from the Hepatorenal Syndrome

Goldstein, H. H.; Boyle, James D.

doi:10.1056/nejm196504292721706

Cited by 52 publications

(9 citation statements)

References 9 publications

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“…The survival rates achieved with OLT in patients with renal failure are far superior to any conservative treatment. 23 In the present study, we excluded patients who underwent combined liver-kidney transplantation. It may be argued that combined liver-kidney transplantation may be a better option in patients with severe renal failure.…”

Section: Discussionmentioning

confidence: 99%

Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation

2002

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The objective of this study was to determine the impact of pretransplant renal function on graft and patient survival rates after orthotopic liver transplantation (OLT) using the United Network for Organ Sharing (UNOS) database for adults who underwent OLT between 1988 and 1996. Based on calculated creatinine clearance (CCr) at the time of OLT, patients were classified arbitrarily into those with normal renal function (>70 mL/min) and mild (40-69.9 mL/min), moderate (20-39.9 mL/min), and severe (<20 mL/min) renal insufficiency. Of the 20,281 patients who underwent transplantation, complete data were available for 19,261 patients. Of these, 12,778 (67%) had normal CCr (mean, 118 ؎ 50 mL/min) and 4,419 (22%) had mild (56 ؎ 8.5 mL/min), 1,560 (8%) had moderate (30 ؎ 5.7 mL/min), and 504 (3%) had severe (14 ؎ 3.6 mL/min) renal failure. UNOS status 1 was more common in patients with moderate and severe renal failure. Primary graft nonfunction and 30-day mortality rates were higher and 1-, 2-, and 5-year graft and patient survival rates were lower in patients with moderate or severe renal failure. Multiple regression analysis showed that renal failure was an independent predictor of 30-day and 2-year mortality after adjusting for the recipient's age, sex, etiology of liver disease, diabetes status, body mass index, cold ischemic time, and UNOS status. CCr less than 40 mL/min was associated with significantly lower short-term and long-term graft and patient survival rates. In conclusion, our findings suggest that when Mayo End-Stage Liver Disease (MELD) score is used to prioritize organ allocation, lower-than-expected graft and patient survival rates may be seen. L iver transplantation has been the most important development in the management of end-stage liver disease in the past 2 decades. The immediate outcome of orthotopic liver transplantation (OLT) is dependent on many factors, including pretransplant serum creatinine levels. Renal insufficiency is common in patients before and after liver transplantation. The prevalence of renal impairment in patients undergoing OLT varies from 10% to 20%. 1-3 Although many of these patients may have hepatorenal syndrome (HRS), a potentially reversible condition, it is often difficult to make a firm diagnosis of HRS in patients with terminal liver disease. 4 Approximately 25% of liver transplantations are complicated by renal failure in the immediate postoperative period. [5][6][7][8] In addition, use of immunosuppressants such as cyclosporine and tacrolimus may cause further deterioration in renal function in this population. [7][8][9][10] Preoperative serum creatinine levels have been shown to be an important predictor of postoperative sepsis, 11,12 number of days spent in the intensive care unit, 3,13 need for preoperative and postoperative dialysis, 2,13 overall cost of liver transplantation, 13,14 and short-term graft and patient survival rates. 1,7,8,11,12,15 In one study, 2-year patient and graft survival rates were found to be similar in 31 patients with HRS and 263 with...

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Section: Discussionmentioning

confidence: 99%

Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation

2002

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“…The relationship between endotoxaemia and progressive functional renal failure is emphasised by the progress of the only patient in this series with progressive renal failure who survived, in whom renal function improved as endotoxaemia disappeared (Figure). A spontaneous improvement of functional renal failure in cirrhosis is observed in a few patients (Goldstein and Boyle, 1965;Conn, 1973), generally with an improvement in the underlying liver disease.…”

Section: Discussionmentioning

confidence: 99%

Functional renal failure and haemorrhagic gastritis associated with endotoxaemia in cirrhosis.

Clemente¹,

Bosch²,

Rodés³

et al. 1977

Gut

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SUMMARY Forty-three patients with cirrhosis and ascites, 21 with normal renal function, 10 with a progressive functional renal failure (FRF), and 12 with a steady FRF, were investigated for the presence of endotoxaemia by the Limulus lysate test. Endotoxaemia was found in nine patients with FRF and in none of the 21 with normal renal function (p < 0-01). A positive Limulus test was almost exclusively associated with a progressive FRF (eight of 10 patients) and all but one of them died. Renal function improved as endotoxaemia disappeared in the survivor. Endotoxaemia was also associated with haemorrhage due to acute erosions of the gastric mucosa, being present in six of the seven patients who had this complication. Intravascular coagulation was not found in any patient. The Limulus test was positive in the ascitic fluid in 18 of 21 patients tested, although only two of them had peritonitis. These results suggest that endotoxaemia may play a critical role in the development of progressive renal failure and haemorrhagic gastritis in cirrhosis, and emphasise the potential risk of procedures involving reinfusion of ascitic fluid.

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“…Survivors are few [51 ] (we are following a patient who is still alive 14 years after a typical episode of HRS during alcoholic cirrhosis). The onset of renal fail ure may be sudden and dramatic, with a rapid and progressive course, occurring in a patient whose renal function appeared to be normal some days before [37,38].…”

Section: Renal Functional Impairment (Rfi) Is a Peculiar Form O F Renmentioning

confidence: 99%

Renal Functional Impairment and Sodium Retention in Liver Cirrhosis

Geñtilini

1989

Digestion

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Spontaneous Recovery from the Hepatorenal Syndrome

Cited by 52 publications

References 9 publications

Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation

Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation

Functional renal failure and haemorrhagic gastritis associated with endotoxaemia in cirrhosis.

Renal Functional Impairment and Sodium Retention in Liver Cirrhosis

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