AKI - Acute Kidney Injury, Hepatorenal Syndrome, Liver Regeneration, Liver Transplant
Conditions
Keywords
Hepatorenal syndrome, HRS, HRS AKI, acute kidney injury, liver transplant, renal biopsy, renal histopathology, transcriptomics
Brief summary
Hepatorenal Syndrome (HRS) is a serious complication that can occur in patients with liver cirrhosis, characterised by kidney dysfunction, or acute kidney failure (AKI). While it has traditionally been thought that HRS affects structurally normal kidneys and is completely reversible with liver transplantation, recent evidence suggests this may not always be the case. The purpose of this study is to examine the actual structural changes in the kidneys of patients with HRS through tissue biopsy and advanced molecular analysis. This may help us better understand the disease mechanism and potentially improve treatment approaches. We aim to challenge the current understanding that HRS always occurs in structurally normal kidneys and is always reversible after liver transplantation. This study will provide valuable insights into the pathophysiology of HRS and may lead to improved diagnostic and treatment strategies in the future. This is a 3-year single center prospective, non-randomised, open label study at Queen Mary Hospital, The University of Hong Kong. All consecutive patients accepted on the liver transplant waiting list will be invited to participate. Patient will undergo several procedures related to liver transplant and kidney assessment, and receive liver transplantation and renal biopsy.
Interventions
PROCEDURErenal biopsy
To examine the actual structural changes in kidneys of patients with HRS through tissue biopsy and advanced molecular analysis, and hope that may help us better understand the disease mechanism and potentially improve treatment approaches
Sponsors
The University of Hong Kong
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patient must be able to understand and provide informed consent 2. Age ≥ 18 years of age at time of study entry 3. Accepted for liver transplantation (LT) 4. Fulfill the diagnostic criteria of HRS AKI according to International Club of Ascites (ICA) guidelines 3-month post transplant renal biopsy inclusion criteria: 1. Patient with adequate intraoperative renal biopsy 2. Patient must be able to understand and provide informed consent
Exclusion criteria
1. Inability or unwillingness to give written informed consent 2. Patient with known pre-existing renal disease 3. Patient with solitary kidney 4. Re-transplantation 5. ABO-incompatible LT 6. Fail to provide 3-month post transplant renal biopsy 3-month post transplant renal biopsy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with HRS AKI | up to 3 years | Proportion of patients with HRS AKI who have normal, reversible or permanent injury on renal histopathology |
| Histopathological changes | up to 3 years | Histopathological changes and their association with clinical parameters |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative morbidity | up to 3 years | Perioperative morbidity including need and duration for renal replacement therapy |
| Duration of HRS AKI | up to 3 years | Incidence and duration of HRS AKI |
| Transcriptomic signature differences | up to 3 years | Transcriptomic signature differences between HRS AKI and non-HRS AKI patients |
| Post-transplant renal recovery rates | up to 3 years | Post-transplant renal recovery rates |
| Response to standard treatment (Terlipressin and albumin) | up to 3 years | Response to standard treatment (Terlipressin and albumin) |
Countries
Hong Kong
Contacts
Primary ContactTiffany Wong
Outcome results
None listed