Recovery of native renal function in patients with hepatorenal syndrome following combined liver and kidney transplant with Mercaptoacetyltriglycine-3 renogram: Developing a methodology
Carina Mari Aparici1, Sukhkarn N Bains2, David Carlson2, Jesse Qian3, Douglas Liou2, David Wojciechowski3, Jacob Werner2, Sana Khan2, Cameron Kroll2, Manreet Sandhu2, Nhan Nguyen2, Randall Hawkins2
1 Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF); Department of Radiology, Nuclear Medicine Division, San Francisco VAMC, San Francisco, California, USA
2 Department of Radiology, Division of Nuclear Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
3 Department of Medicine, Division of Nephrology, University of California, San Francisco (UCSF), San Francisco, California, USA
Carina Mari Aparici
Department of Radiology and Biomedical Imaging, UCSF Nuclear Medicine Section, University of California, San Francisco, California
Many patients with hepatorenal syndrome (HRS) end up receiving a combined liver and kidney transplant (CKLT) with preservation of native kidneys, specially type 1 HRS since is characterizes by a very rapid deterioration of renal function. 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 if there is recovery of native renal function in patients with HRS following CKLT. 22 patients (16 men; 6 women) with history of HRS and status post CKLT were studied. Mercapto-acetyltriglycine-3 renograms in the anterior and posterior views with the three 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 for the transplanted and native kidneys were obtained. 1/22 (4.5%) patients presented with a very poor functioning transplanted kidney, in 15/22 (68%) cases the combined native renal function was markedly poorer than the transplanted renal function and in 6/22 (27%) native kidneys showed a contribution to the renal function similar to the transplanted kidney. In conclusion, our series show that around 32% 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 and cost, while facilitating a reallocation of scarce donor resources.