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Liver Transplant Outcomes for Patients With Hepatorenal Syndrome Treated With Pretransplant Vasoconstrictors and Albumin

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 m2, 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 m2, 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.