Role of liver transplantation in the treatment of HRS

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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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