Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
Transplantation. 2011 May 27;91(10):1141-7. doi: 10.1097/TP.0b013e31821690bf.
The combination of octreotide, midodrine, and albumin (triple therapy) is used to treat hepatorenal syndrome (HRS) often as a bridge to liver transplantation (LT). We examined post-LT outcomes in recipients with HRS, including the effect of pre-LT triple therapy.
Patients with HRS treated with triple therapy (cases) pre-LT were compared with a cohort that underwent LT in the immediate era before triple therapy was used (controls).
Forty-three patients with HRS underwent LT (27 cases and 16 controls). Twenty-one patients (49%) required hemodialysis (HD) pre-LT (48% of cases vs. 50% of controls, P=1.00). After LT, mean glomerular filtration rate (GFR) was similar between cases and controls at 1 month (56.9 vs. 52.6 mL/min/1.73 m(2), P=0.61) and at 1 year (P=0.13). Of the 27 cases, 11 responded to triple therapy pre-LT. Compared with nonresponders, there was no difference in GFR at 1 month (57.2 vs. 56.6 mL/min/1.73 m, P=0.96) or 1 year (P=0.48) post-LT. Long-term HD after LT was required in 7.7% of cases and 12.5% of controls (P=0.61).
LT alone improved renal function in most patients with HRS, including those requiring short-term HD. Pre-LT treatment of HRS with triple therapy was not associated with additional benefit in GFR after LT.
奥曲肽、米多君和白蛋白（三联疗法）联合用于治疗肝肾综合征（HRS），通常作为肝移植（LT）的桥梁。我们检查了 HRS 患者 LT 后的结果，包括 LT 前三联疗法的影响。
将 LT 前接受三联疗法治疗的 HRS 患者（病例组）与 LT 前未使用三联疗法的同期队列（对照组）进行比较。
43 例 HRS 患者接受 LT（27 例病例组和 16 例对照组）。21 例患者（49%）LT 前需要血液透析（HD）（病例组 48%，对照组 50%，P=1.00）。LT 后，病例组和对照组在 1 个月时的平均肾小球滤过率（GFR）相似（56.9 vs. 52.6 mL/min/1.73 m2，P=0.61），1 年时相似（P=0.13）。27 例病例中，11 例对 LT 前的三联疗法有反应。与无反应者相比，1 个月时的 GFR 无差异（57.2 vs. 56.6 mL/min/1.73 m，P=0.96）或 1 年后（P=0.48）。LT 后需要长期 HD 的病例为 7.7%，对照组为 12.5%（P=0.61）。
LT 本身可改善大多数 HRS 患者的肾功能，包括需要短期 HD 的患者。LT 前 HRS 三联疗法治疗并未导致 LT 后 GFR 额外获益。
