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Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1*
Article first published online: 26 OCT 2011
Copyright © 2011 American Association for the Study of Liver Diseases
Volume 17, Issue 11, pages 1328–1332, November 2011
How to Cite
Boyer, T. D., Sanyal, A. J., Garcia-Tsao, G., Regenstein, F., Rossaro, L., Appenrodt, B., Gülberg, V., Sigal, S., Bexon, A. S., Teuber, P. and the Terlipressin Study Group (2011), Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1. Liver Transpl, 17: 1328–1332. doi: 10.1002/lt.22395
The members of the study group are listed in the Supporting Information.
- Issue published online: 26 OCT 2011
- Article first published online: 26 OCT 2011
- Accepted manuscript online: 11 AUG 2011 09:34AM EST
- Manuscript Accepted: 5 JUL 2011
- Manuscript Received: 14 FEB 2011
The development of hepatorenal syndrome type 1 (HRS1) is associated with a poor prognosis. Liver transplantation improves this prognosis, but the degree of the improvement is unclear. Most patients receive vasoconstrictors such as terlipressin before transplantation, and this may affect the posttransplant outcomes. We examined a cohort of patients with access to liver transplantation from our previously published study of terlipressin plus albumin versus albumin alone in the treatment of HRS1. The purpose of this analysis was the quantification of the survival benefits of liver transplantation for patients with HRS1. Ninety-nine patients were randomized to terlipressin or placebo. Thirty-five patients (35%) received a liver transplant. Among those receiving terlipressin plus albumin, the 180-day survival rates were 100% for transplant patients and 34% for nontransplant patients; among those receiving only albumin, the rates were 94% for transplant patients and 17% for nontransplant patients. The survival rate was significantly better for those achieving a reversal of hepatorenal syndrome (HRS) versus those not achieving a reversal (47% versus 4%, P < 0.001), but it was significantly lower for the responders versus those undergoing liver transplantation (97%). We conclude that the use of terlipressin plus albumin has no significant impact on posttransplant survival. Liver transplantation offers a clear survival benefit to HRS1 patients regardless of the therapy that they receive or the success or failure of HRS reversal. The most likely benefit of terlipressin in patients undergoing liver transplantation for HRS1 is improved pretransplant renal function, and this should make the posttransplant management of this difficult group of patients easier. For patients not undergoing transplantation, HRS reversal with terlipressin and/or albumin improves survival. Liver Transpl 17:1328–1332, 2011. © 2011 AASLD.