{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:35:03Z","timestamp":1753893303456,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Hepatorenal syndrome (HRS) is a disastrous renal complication of advanced liver disease with a poor prognosis. Restoring normal liver function through liver transplantation (LT) is a standardized treatment with favorable short-term survival. However, the long-term renal outcomes in patients with HRS receiving living donor LT (LDLT) are controversial. This study aimed to investigate the prognostic impact of LDLT in patients with HRS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed adult patients who underwent LDLT between July 2008 and September 2017. Recipients were classified into 1) HRS type 1 (HRS1, <jats:italic>N<\/jats:italic>\u2009=\u200911), 2) HRS type 2 (HRS2, <jats:italic>N<\/jats:italic>\u2009=\u200919), 3) non-HRS recipients with pre-existing chronic kidney disease (CKD, <jats:italic>N<\/jats:italic>\u2009=\u200943), and 4) matched normal renal function (<jats:italic>N<\/jats:italic>\u2009=\u200967).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Postoperative complications and 30-day surgical mortality were comparable among the HRS1, HRS2, CKD, and normal renal function groups. The 5-year survival rate was &amp;gt;90% and estimated glomerular filtration rate (eGFR) transiently improved and peaked at 4 weeks post-transplantation in patients with HRS. However, renal function deteriorated and resulted in CKD stage\u2009\u2265\u2009III in 72.7% of HRS1 and 78.9% of HRS2 patients (eGFR &amp;lt;60\u2005ml\/min\/1.73\u2005m<jats:sup>2<\/jats:sup>). The incidence of developing CKD and end-stage renal disease (ESRD) was similar between the HRS1, HRS2, and CKD groups, but significantly higher than that in the normal renal function group (both <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001). In multivariate logistic regression, pre-LDLT eGFR &amp;lt;46.4\u2005ml\/min\/1.73\u2005m<jats:sup>2<\/jats:sup> predicted the development of post-LDLT CKD stage\u2009\u2265\u2009III in patients with HRS (AUC\u2009=\u20090.807, 95% CI\u2009=\u20090.617\u20130.997, <jats:italic>P<\/jats:italic>\u2009=\u20090.011).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LDLT provides a significant survival benefit for patients with HRS. However, the risk of CKD stage\u2009\u2265\u2009III and ESRD among patients with HRS was similar to that in pre-transplant CKD recipients. An early preventative renal-sparing strategy in patients with HRS is recommended.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1116728","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T05:00:06Z","timestamp":1680498006000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-term renal outcomes comparison between patients with chronic kidney disease and hepatorenal syndrome after living donor liver transplantation"],"prefix":"10.3389","volume":"10","author":[{"given":"Hsiang-Yu","family":"Tseng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Hung","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Che","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao-Long","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chee-Chien","family":"Yong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Man","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Chi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Chia","family":"Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1016\/j.jhep.2019.07.002","article-title":"News in pathophysiology, definition and classification of hepatorenal syndrome: a step beyond the international club of ascites (ICA) consensus document","volume":"71","author":"Angeli","year":"2019","journal-title":"J Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"100236","DOI":"10.1016\/j.aohep.2020.07.008","article-title":"An integrated review of the hepatorenal syndrome","volume":"22","author":"Ojeda-Yuren","year":"2021","journal-title":"Ann Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"192","DOI":"10.14218\/JCTH.2020.00011","article-title":"Management of hepatorenal syndrome: a review","volume":"8","author":"Tariq","year":"2020","journal-title":"J Clin Transl Hepatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"5362810","DOI":"10.1155\/2018\/5362810","article-title":"Clinical outcomes after liver transplantation for hepatorenal syndrome: a systematic review and meta-analysis","volume":"2018","author":"Utako","year":"2018","journal-title":"Biomed Res Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2788","DOI":"10.1111\/ajt.12975","article-title":"Living vs. Deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: a matched case-control study","volume":"14","author":"Goldaracena","year":"2014","journal-title":"Am J Transplant"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1002\/lt.26096","article-title":"Excellent outcome in living donor liver transplantation: treating patients with acute-on-chronic liver failure","volume":"27","author":"Wang","year":"2021","journal-title":"Liver Transpl"},{"key":"B7","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1002\/lt.23401","article-title":"Outcomes of living donor liver transplantation for patients with preoperative type 1 hepatorenal syndrome and acute hepatic decompensation","volume":"18","author":"Chok","year":"2012","journal-title":"Liver Transpl"},{"key":"B8","doi-asserted-by":"publisher","first-page":"100559","DOI":"10.1016\/j.aohep.2021.100559","article-title":"Improvement of renal function prior to liver transplantation is not associated with better long-term renal outcome or survival","volume":"26","author":"Horvatits","year":"2021","journal-title":"Ann Hepatol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1136\/gutjnl-2014-308874","article-title":"Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the international club of ascites","volume":"64","author":"Angeli","year":"2015","journal-title":"Gut"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1681\/ASN.V451159","article-title":"Glomerular filtration rate measurements in clinical trials. 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