Hepatorenal syndrome: a proposal for kidney after liver transplantation (KALT)

Area of Science:

• Nephrology
• Hepatology
• Transplantation

Background:

• Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease.
• Traditionally, HRS was considered reversible post-liver transplantation (LT), but it can necessitate long-term dialysis.
• The role of kidney transplantation in HRS patients is under debate.

Purpose of the Study:

• To evaluate the incidence and outcomes of HRS in patients undergoing LT.
• To assess the impact of HRS on post-transplant survival and kidney function.
• To explore the potential benefit of kidney after liver transplantation (KALT) for HRS patients.

Main Methods:

• Retrospective analysis of 130 patients undergoing LT over 10 years.
• Defined HRS using International Ascites Club guidelines (pretransplant serum creatinine >2.0 mg/dL).
• Compared survival and post-transplant kidney failure rates between HRS and non-HRS groups.

Main Results:

• The incidence of HRS among LT patients was 9%.
• HRS patients had significantly worse 1, 3, and 5-year survival rates compared to non-HRS patients (P=0.0001).
• Type 2 HRS patients showed a higher incidence of irreversible kidney failure post-LT (6% vs. 0.34%, P<0.0001).

Conclusions:

• Combined liver and kidney transplantation (CLKT) is not recommended for HRS patients.
• Kidney after liver transplantation (KALT) may be a viable option for select HRS patients.
• Addressing the need for dialysis >60 days post-transplant can improve outcomes in HRS patients.