Patricia Viana, Jorge Persson, Maria Clara Merighi, Emilia D. Juvencio, Guilherme F. Machado, Milena Martins-Moretti, Rafael Morriello, Paulo N. Martins
Experimental and Clinical Transplantation - 2025;23(9):587-594
Objectives: Hepatorenal syndrome is a severe com- plication of end-stage liver disease, associated with poor prognosis and increased risk of renal dysfunction after liver transplant. With the effects of hepatorenal syndrome on outcomes after living donor liver transplant not yet fully established, we conducted a systematic review to evaluate the effect of hepa-takenal syndrome on posttransplant outcomes. Materials and Methods: We searched PubMed, Embase, and Cochrane for studies comparing living donor liver transplant outcomes in patients with and without hepatorenal syndrome. We used risk ratios for binary outcomes and mean differences for continuous variables. P < .05 was considered significant. We used R Studio 4.3.1 with a random-effects model to conduct the statistical analyses. Results: In 4 retrospective studies on living-donor liver transplant, which included 2931 patients, patients with (n = 313; 10.7%) and without hepatorenal syndrome were compared. The hepatorenal syndrome group had significantly lower 5-year patient survival (risk ratio 0.91; 95% CI, 0.85-0.95; P = .005), higher hospital mortality (risk ratio 2.38; 95% CI, 1.52-3.72; P < .001), increased posttransplant bleeding (risk ratio 2.32; 95% CI, 1.45-3.69; P < .001), and greater need for renal replacement therapy (risk ratio 9.4; 95% CI, 5.46-16.19; P < .001). No significant difference was found for hospital stay duration (mean difference 19.24 days; P = .44). A meta-regression of the effect of the Model for End-Stage Liver Disease score on 5-year patient survival also showed no significant association. In the proportional analysis of only patients with hepatorenal syndrome, pooled 5-year patient survival was 77.02 per 100 observations (95% CI, 64.26-86.20), whereas pooled incidence of renal replacement therapy was 27.40 per 100 observations (95% CI, 12.41-50.15). Conclusions: Living-donor liver transplant in patients with hepatorenal syndrome carries a higher risk of hospital mortality and early posttransplant compli- cations, with reduced 5-year survival.
