Clinical Outcomes after Liver Transplantation for Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

AIMS: Hepatorenal syndrome (HRS) decreases survival of cirrhotic patients. The outcomes of HRS after liver transplantation (LT) were inconsistently reported. We conducted a systematic review and meta-analysis study to estimate the post-LT rates of death and HRS reversal. METHODS: A thorough search of literatures was performed on PubMed, Scopus, and conference abstracts for reports on post-LT survival and HRS reversal. Data for the posttransplant rates of HRS reversal, death, and acute rejection were extracted. The rates were pooled using inverse variance method if there was no heterogeneity between studies. Otherwise, the random effect model was applied. RESULTS: Twenty studies were included. Pooling HRS reversal rates indicated high heterogeneity with a pooled rate of 0.834 (95% CI: 0.709–0.933). The pooled overall death rates for HRS and non-HRS after LT were 0.25 (95% confidence interval (CI): 0.18–0.33) and 0.19 (95% CI: 0.14–0.26). The risk ratio of death between HRS and non-HRS patients was 1.29 (95% CI: 1.14–1.47, P < 0.001). The probability of death at 1, 3, and 5 years tended to be higher among HRS. CONCLUSIONS: HRS is reversible in about 83% of patients after LT. However, the posttransplant mortality rate of HRS patients is still increased.