Hepatorenal syndrome-acute kidney injury (HRS-AKI) is associated with significant morbidity and mortality. While liver transplantation is the definitive treatment, continuous terlipressin infusion for HRS-AKI may provide benefit and, as such, was assessed in a population composed of candidates for liver transplant (LT). Fifty hospitalized LT-eligible patients with HRS-AKI received a single bolus followed by continuous terlipressin infusion. Acute-on-chronic liver failure grade 3, serum creatinine (SCr)>5.0 mg/dL, or Model for End-Stage Liver Disease (MELD) ≥35 were exclusions. Fifty hospitalized patients who received midodrine and octreotide or norepinephrine for HRS-AKI served as a historical comparator cohort. Complete response (CR) was defined as a ≥30% decrease in SCr with end-of-treatment (EOT) SCr≤1.5, partial response as a ≥30% decrease in SCr with EOT SCr>1.5, and nonresponse as a <30% decrease in SCr. CR rate was significantly higher in the terlipressin cohort compared to the historical cohort (64% vs. 16%, p <0.001). Survival, while numerically higher in those who received terlipressin, was statistically similar (D30: 94% vs. 82%, p =0.12; D90: 78% vs. 68%, p =0.37). Renal replacement therapy (RRT) was more common among terlipressin NR than CR and PR (70% vs. 3% vs. 13%, p < 0.001). EOT MELD and SCr were significantly lower within terlipressin cohort (MELD: 19 vs. 25, SCr: 1.4 vs. 2.1 mg/dL, p <0.001). Sixteen of 40 terlipressin-treated patients received LT-alone (terlipressin CR in 10/16). One patient on terlipressin had a hypoxic respiratory failure that responded to diuretics; one possibly had drug-related rash. With continuous terlipressin infusion, a CR rate of 64% was observed with a favorable safety profile. Terlipressin use was associated with lower EOT MELD and SCr than the historical midodrine and octreotide/norepinephrine cohort; LT-alone was accomplished in a high proportion of complete terlipressin responders.
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| http://dx.doi.org/10.1097/LVT.0000000000000399 | DOI Listing |
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Article Synopsis
- Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a serious complication of chronic liver disease that leads to high rates of illness and death, and terlipressin, a vasopressin analog, shows promise in treating it by effectively managing blood pressure and reducing side effects during continuous infusion.
- This study evaluated the safety and effectiveness of administering terlipressin at a continuous rate of 4 mg/day in patients with HRS-AKI, involving 136 participants who were monitored for their response to treatment and side effects.
- Results indicated that 69.1% of patients experienced a reduction in serum creatinine levels, with an average treatment duration of 7.6 days, although 21.
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Department of Medicine, University of Melbourne, Victoria, Australia; Victorian Liver Transplant Unit, Austin Health, Heidelberg, Australia; Australian Centre for Transplantation Excellence and Research, Melbourne, Australia; Australian Cardiovascular Collaborative in Liver Transplant Medicine, Melbourne, Australia. Electronic address:
Article Synopsis
- Long-term use of terlipressin, a treatment for hepatorenal syndrome, may improve subclinical cardiac dysfunction in patients with decompensated cirrhosis, as suggested by a study of 22 patients.
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Hepatorenal syndrome-acute kidney injury (HRS-AKI) is associated with significant morbidity and mortality. While liver transplantation is the definitive treatment, continuous terlipressin infusion for HRS-AKI may provide benefit and, as such, was assessed in a population composed of candidates for liver transplant (LT). Fifty hospitalized LT-eligible patients with HRS-AKI received a single bolus followed by continuous terlipressin infusion.
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