Long-term survival and renal function following liver transplantation in patients with and without hepatorenal syndrome — Experience in 300 patients

We have retrospectively reviewed the first 308 patients undergoing orthotopic liver transplantation (OLTX) at our institution to determine the following: 1) To what extent does renal function deteriorate postop- eratively? 2) To what extent does renal function recover after OLTX for hepatorenal syndrome (HRS)? 3) What is the survival rate of patients with HRS compared with those without HRS? In non-HRS patients, GFR declined from 97.1±2.9 cc/ min to 56.6±2.4 cc/min at 6 weeks postoperative, 62.6± 2.6 cc/min at 1 year, and 58.3±3.5 cc/min at 2 years. In HRS patients, GFR increased from 19.9±3.6 cc/min to 32.5±3.1 cc/min at 6 weeks, 45.9±5.5 cc/min at 1 year, and 37.9±5.9 cc/min at 2 years. Dosages of cyclosporine were comparable in both groups. There was no difference in perioperative (90-day) mortality. One- and 2- year actuarial survival rates in the non-HRS patients were 87.2% and 82.1%, respectively. The actuarial 1- and 2-year survival rate for the HRS patients was 76.6% (P=NS). Ten percent of HRS patients developed ESRD posttransplant compared with 0.8% of non-HRS patients (P<0.005). We conclude that patients with HRS can safely undergo OLTX with acceptable perioperative mortality and good long-term survival. Most HRS patients have return of acceptable renal function. Patients without HRS have a severe decline in GFR posttransplant, which is stable up to 3 years posttransplant.