肝肾综合征患者在肝移植前使用血管收缩剂和白蛋白治疗的肝移植结局。

Liver transplant outcomes for patients with hepatorenal syndrome treated with pretransplant vasoconstrictors and albumin.

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.

出版信息

Transplantation. 2011 May 27;91(10):1141-7. doi: 10.1097/TP.0b013e31821690bf.

DOI:10.1097/TP.0b013e31821690bf

PMID:21544034

Abstract

BACKGROUND

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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）。