Outcomes for hepatorenal syndrome and acute kidney injury in patients undergoing liver transplantation: a single-center experience

Acute kidney injury occurs commonly among patients with advanced liver disease. These patients may undergo liver transplantation with subsequent improvement in hepatic function. However, the renal outcomes of these patients after liver transplantation has only occasionally been reported. Knowledge of these outcomes would be useful to identify patients who may benefit from combined liver-renal transplantation. We retrospectively analyzed 29 patients who subsequently went on to have a liver transplantation. Seventeen of cases could be ascribed to hepatorenal syndrome (HRS) and 12 cases to ATN. Four patients with non-HRS and 12 patients with HRS required hemodialysis prior to transplantation. The duration of kidney injury prior to transplantation was 7.75 +/- 7.53 weeks in the HRS group and 5.09 +/- 4.47 weeks in the ATN group (P = NS). Demographic variables between patients with HRS and ATN were similar with the exception of a higher prevalence of diabetes among the ATN group (P < .05). At 3 months post-liver transplantation, 66% of patients with non-HRS and 77% of those surviving patients with HRS showed serum creatinine values less than 1.5 mg/dL. No patients remained on chronic hemodialysis at 3 months post-liver transplantation. The outcome of kidney dysfunction and more specifically, HRS, among those patients surviving to liver transplantation was excellent with subsequent resolution in the majority of patients. Determination of prognostic factors for renal outcome will require multicenter prospective trials, which would be useful to determine which patients benefit from combined liver-renal transplantation.