Search

Introduction and Objectives: Since MELD implementation renal impairment in liver transplant (LT) recipients has become of increasing importance. This is the first study evaluating the course of renal function immediately prior to LT as predictor for long-term renal and overall outcome., Patients and Methods: In this retrospective study, 226 adults undergoing LT at the University Medical Center Hamburg-Eppendorf (2011-2015) were included. The impact of renal function over a period of 3 months prior to LT compared to renal function at the day of LT on long-term renal outcome and survival was assessed., Results: According to GFR at day of LT renal function improved (≥1 CKD stage) in 64 patients (28%), remained stable in 144 (64%) or deteriorated in 18 (8%). Improvement of renal function prior to LT did neither significantly affect 90-day (13% vs. 14%, p = 0.83), nor 5-year post-LT mortality (35% vs. 41%, p = 0.57). 50 patients (22%) with hepatorenal syndrome (HRS) received terlipressin prior to LT, but only 18 (37%) showed prolonged stabilization of renal function (improvement ≥1 CKD stage). Response to terlipressin did neither improve 90-day (p=1), 5-year mortality (p = 0.52) nor long-term renal function (p = 0.843). Nevertheless, need for dialysis pre-LT (59% vs. 34%, p = 0.005) and post-LT (62% vs. 17%, p<0.001) was associated with increased 5-year mortality., Conclusions: Improvement of renal function immediately prior to LT, either spontaneously or following terlipressin therapy, did neither ameliorate long-term renal outcome nor survival in LT recipients. Future studies need to clarify the impact of terlipressin in HRS on the transplant waiting time in LT candidates., Competing Interests: Conflicts of interest The authors declare that they have no conflict of interest., (Copyright © 2021 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Aim: Extracorporeal liver assist devices are besides causal and symptomatic approaches important therapeutic options in acute-on-chronic (AOC) liver failure. In this retrospective analysis, albumin dialysis was compared to therapeutic plasma exchange (TPA) under various aspects., Patients and Methods: Data from 20 patients per group (10 women, 10 men in each group, mean age 51 ± 12,6 years and 48,2 ± 15,2 years, respectively) treated over a period of 3 months were analyzed. During the first treatment, 5 sessions of dialysis were performed (week 1) for both procedures, 3 more sessions were completed in the second and in the third week each. Data were acquired on days 1, 8, 13, 20, 28 and 90., Results: After 28 days, 13 out of 20 patients following albumin dialysis and 7 out of 20 patients following plasma exchange had survived (p = 0,11). After 90 days, 10 patients following albumin dialysis and 5 patients following plasma exchange were alive (p = 0,19). Degree of hepatic encephalopathy (HE) had not improved significantly. Rates of complication (infections, bleeding or system clotting) were similar under both procedures., Conclusion: Extracorporeal liver assist devices can be considered equally well as a therapeutic option in acute-on-chronic liver failure. Differences in 90-day survival were not observed in our study., (© Georg Thieme Verlag KG Stuttgart · New York.)