BACKGROUND: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis. Recently, ornipressin, a potent splanchnic vasoconstrictor, was reported to improve renal function in patients with HRS. However, this treatment is associated with a high incidence of vascular complications. Terlipressin is thought to be as effective as ornipressin with less systemic complications. AIMS: To evaluate the effectiveness and safety of terlipressin administration in cirrhotic patients with type 1 HRS. PATIENTS: Twelve consecutive patients fulfilling HRS criteria of the International Ascites Club were included in the study. Median plasma creatinine and sodium, urine volume and sodium before treatment were 3.4 mg% (2.5-4.0); 127 mEq/l (124-130), 500 ml/24 h (100-1031) and 7 mEq/24 h (1-17). METHODS: Terlipressin was administered i.v. 2 mg bid in 8 patients and tid in 4 others for at least one week and up to 2 months. RESULTS: After one week of treatment median plasma creatinine decreased to 1.8 mg% (1.3-2.1) together with an increase in urine volume, sodium excretion, creatinine and free-water clearance. Three patients underwent successful liver transplantation with a near normal renal function after 34, 36 and 111 days. The 9 other patients died during follow-up (4 from sepsis, 2 from digestive bleeding and 3 from liver failure). No ischaemic complications were encountered during the treatment. CONCLUSIONS: Long-term terlipressin administration is safe and effective to control type 1 HRS. However, it does not cure the underlying disease and therefore, may only be considered as a bridge to a definitive treatment as liver transplantation.
BACKGROUND:Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis. Recently, ornipressin, a potent splanchnic vasoconstrictor, was reported to improve renal function in patients with HRS. However, this treatment is associated with a high incidence of vascular complications. Terlipressin is thought to be as effective as ornipressin with less systemic complications. AIMS: To evaluate the effectiveness and safety of terlipressin administration in cirrhotic patients with type 1 HRS. PATIENTS: Twelve consecutive patients fulfilling HRS criteria of the International Ascites Club were included in the study. Median plasma creatinine and sodium, urine volume and sodium before treatment were 3.4 mg% (2.5-4.0); 127 mEq/l (124-130), 500 ml/24 h (100-1031) and 7 mEq/24 h (1-17). METHODS: Terlipressin was administered i.v. 2 mg bid in 8 patients and tid in 4 others for at least one week and up to 2 months. RESULTS: After one week of treatment median plasma creatinine decreased to 1.8 mg% (1.3-2.1) together with an increase in urine volume, sodium excretion, creatinine and free-water clearance. Three patients underwent successful liver transplantation with a near normal renal function after 34, 36 and 111 days. The 9 other patients died during follow-up (4 from sepsis, 2 from digestive bleeding and 3 from liver failure). No ischaemic complications were encountered during the treatment. CONCLUSIONS: Long-term terlipressin administration is safe and effective to control type 1 HRS. However, it does not cure the underlying disease and therefore, may only be considered as a bridge to a definitive treatment as liver transplantation.
Authors: Juan Carlos Q Velez; Manish Kadian; Margarita Taburyanskaya; Nicole M Bohm; Tracie A Delay; Nithin Karakala; Don C Rockey; Paul J Nietert; Andrew J Goodwin; Timothy P Whelan Journal: Nephron Date: 2015-10-21 Impact factor: 2.847
Authors: Arun J Sanyal; Thomas Boyer; Guadalupe Garcia-Tsao; Frederick Regenstein; Lorenzo Rossaro; Beate Appenrodt; Andres Blei; Veit Gülberg; Samuel Sigal; Peter Teuber Journal: Gastroenterology Date: 2008-02-13 Impact factor: 22.682