Sourianarayanane Achuthan, Raina Rupesh, Garg Gaurav, McCullough Arthur J, O'Shea Robert S
Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA,
Int Urol Nephrol. 2014 Apr;46(4):793-800. doi: 10.1007/s11255-013-0527-7. Epub 2013 Aug 10.
Hepatorenal syndrome (HRS) type I is a devastating complication of decompensated cirrhosis. Liver transplantation (LT) offers an excellent survival, and renal replacement therapy (RRT) may be useful until transplantation is available. The survival benefit of RRT in the absence of LT is thought to be short and its benefit in these patients is unknown. To investigate this, we studied the outcome of different therapies (pharmacological, RRT, and LT) in patients with type 1 HRS.
Medical records (2005-2009) of all cirrhotic patients admitted to our facility with abnormal renal function were reviewed. Patients with preexisting renal disease, diagnosis other than type I HRS, or those without long-term follow-up were excluded.
Of 380 patients reviewed, 30 were studied. Nineteen (63.3 %) patients underwent liver transplantation. No difference in baseline liver or renal parameters was noted between those who were or were not transplanted. A decreased mortality was noted (5.3 vs. 64.6 %; p = 0.0005) compared to patients who were not transplanted during the study follow-up median period of 7.8 [CI 1.9-34] months. Among non-transplanted patients, no differences in median survival (8.8 vs. 6.5 months; p = 0.62) or in other parameters studied were found in those patients who received RRT compared to those who did not. Similarly, no survival difference was found comparing those who did or did not receive pharmacological therapy without transplant.
In type I HRS, LT offers better survival. Among patients who do not receive LT, RRT does not provide an improved survival benefit.
I型肝肾综合征（HRS）是失代偿期肝硬化的一种严重并发症。肝移植（LT）可带来良好的生存率，在可进行移植前，肾脏替代治疗（RRT）可能有用。在未进行肝移植的情况下，RRT的生存获益被认为是短暂的，其对这些患者的益处尚不清楚。为了研究这一点，我们对I型HRS患者不同治疗方法（药物治疗、RRT和LT）的结果进行了研究。
回顾了2005年至2009年我院收治的所有肾功能异常的肝硬化患者的病历。排除既往有肾脏疾病、诊断不是I型HRS或未进行长期随访的患者。
在380例接受评估的患者中，30例被纳入研究。19例（63.3%）患者接受了肝移植。移植组和未移植组在基线肝脏或肾脏参数方面未发现差异。在研究随访的中位时间7.8[CI 1.9 - 34]个月期间，与未移植患者相比，移植患者的死亡率降低（5.3%对64.6%；p = 0.0005）。在未移植患者中，接受RRT的患者与未接受RRT的患者相比，中位生存期（8.8个月对6.5个月；p = 0.62）或其他研究参数均无差异。同样，未移植情况下接受或未接受药物治疗的患者之间也未发现生存差异。
在I型HRS中，肝移植可带来更好的生存率。在未接受肝移植的患者中，肾脏替代治疗并不能提高生存获益。
