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Evaluation of recovery of native renal function in patients with hepatorenal syndrome following liver and kidney transplant. Is kidney transplantation necessary?

¹ Radiology, UCSF, San Francisco, California

543

Objectives: Many patients with Hepatorenal Syndrome (HRS) end up receiving a Combined Liver and Kidney Transplant (CKLT) with preservation of native kidneys. Eventually, most of the patients regain renal function, but it is unknown if this is due to the transplanted kidney, the recovery of native renal function, or both. The aim of this study is to evaluate recovery of native renal function in patients with HRS following CKLT.

Methods: 20 patients (15 men;5 women) with history of HRS and status post CKLT were studied. MAG-3 renograms in the anterior and posterior views with the 3 kidneys in the field of view were simultaneously acquired. The renograms were analyzed by creating regions of interest around the transplanted and native kidneys. Relative contribution to the renal function, clearance, and effective renal plasma flow (ERPF) for the transplanted and native kidneys were obtained.

Results: Only 1/20 (5%) patients presented with a very poor functioning transplanted kidney (uptake: 4.7%, clearance: 42 ml/min and ERPF: 34 ml/min). In 13/20 (65%) cases, the combined native renal function was markedly poorer than the transplanted renal function (uptake: 21±6 vs 81±6 %, clearance: 34±21 vs 223±39 ml/min, ERPF: 97±46 vs 479±89 ml/min). In 6/20 (30%) native kidneys showed a contribution to the renal function similar to the transplanted kidney (uptake: 48±9 vs 52±9 %, clearance: 117±31 vs 159±47 ml/min, ERPF: 235±57 vs 323±103 ml/min).

Conclusions: In our series, 1/3 of the HRS patients recovered their native renal function after CKLT. Identification of common factors that affect recovery of native renal function may help to avoid unnecessary renal transplants, significantly reducing morbidity & cost, while facilitating a reallocation of scarce donor resources.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Carlson, D. Articles by Mari, C. PubMed Articles by Carlson, D. Articles by Mari, C.