Role of liver transplantation in the treatment of HRS

Role of liver transplantation in the treatment of HRS

How is liver transplantation used in the treatment of HRS?

Liver transplant is the definitive treatment for both AKI-HRS and chronic type 2 HRS. It corrects liver dysfunction and eliminates portal hypertension—the two pivotal pathogenetic mechanisms for the development of HRS.

However, only 50% to 75% of patients with pre-transplant AKI-HRS will achieve normal kidney function following transplant, and this reversal to normal kidney function is independent of pre-transplant pharmacotherapy and dialysis. Dialysis is frequently started to deal with the electrolyte abnormalities and volume overload issues pre–liver transplant. Many studies have shown that the longer a patient is on dialysis pre-transplant, the less likely they are to reverse kidney dysfunction. Most guidelines suggest that patients should be considered for a combined liver and kidney transplant if they have spent a prolonged period on dialysis pre-transplant (≥8 weeks); however, there is no consensus on how long “a prolonged period” is. Liver transplantation reverses chronic type 2 HRS in the majority of patients with survival outcomes comparable to matched controls.

For patients with AKI-HRS, overall survival is significantly better for those who recover kidney function post-transplant; therefore it is imperative that these patients are offered a timely liver transplant. The use of living donor liver transplants appears to provide similar results to cadaveric liver transplant donation.

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