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Cheung et al. Hepatoma Res 2017;3:67-72 Hepatoma Research
DOI: 10.20517/2394-5079.2016.48
www.hrjournal.net
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Updates on hepatorenal syndrome and

strategies bridging to liver transplantation

Chung Yeung Cheung , Kenneth S.H. Chok 2,3
1
1 Department of Surgery, Queen Mary Hospital, 9990777 Hong Kong, China.
2 Department of Surgery, University of Hong Kong, 999077 Hong Kong, China.
3 State Key Laboratory for Liver Research, University of Hong Kong, 999077 Hong Kong, China.

Correspondence to: Dr. Kenneth S.H. Chok, Department of Surgery, University of Hong Kong, 102 Pok Fu Lam Road, 999077 Hong Kong, China.
E-mail: kennethchok@gmail.com

How to cite this article: Cheung CY, Chok KSH. Updates on hepatorenal syndrome and strategies bridging to liver transplantation. Hepatoma Res
2017;3:67-72.
ABSTRACT

Article history: Hepatorenal syndrome is not an uncommon life-threatening complication arising from liver
Received: 01-12-2016 cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years,
Accepted: 08-02-2017 with recent revisions aimed at improving earlier diagnosis and treatment. Liver transplantation
Published: 12-04-2017 remains the only definitive treatment for hepatorenal syndrome. Due to the scarcity of liver
grafts, many patients die waiting. This review focuses on the different strategies to bridge
Key words: patients to liver transplantation and to improve the postoperative outcome.
Hepatorenal syndrome,
liver cirrhosis,
terlipressin,
liver transplantation,
portal hypertension,
acute kidney injury

DEFINITION OF HEPATORENAL and water retention and hypoalbuminemia due to
SYNDROME poor synthetic function of the liver, causes decreased
glomerular filtration rate (GFR), ascites, and edema. [1,4]
Hepatorenal syndrome (HRS) is the deterioration of renal
function resulting from cirrhosis. Portal hypertension Diagnostic criteria of HRS have been revised
[1]
leads to splanchnic vasodilatation, accompanied by throughout the years. They were initially defined
gradual decrease in systemic vascular resistance. by the International Ascites Club (IAC) in 1996,
[2]
The fall in systemic arterial pressure, or so-called based on major and minor criteria to characterize
“arterial under filling”, is compensated by an increase the occurrence of renal failure in cirrhotic patients.
[5]
in cardiac output by activating the renin-angiotensin- Major criteria can be summarized as the presence
aldosterone system and sympathetic nervous system, of liver failure and portal hypertension and acute
which causes vasoconstriction of renal arteries. renal failure, while excluding shock, ongoing sepsis,
[3]
Resulting renal hypoperfusion, together with sodium nephrotoxic drug, hypovolemia, nephrotic syndrome,
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