Long-term terlipressin administration improves renal function in cirrhotic patients with type 1 hepatorenal syndrome: a pilot study.
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.


OBJECTIVE
To evaluate the effectiveness and safety of terlipressin administration in cirrhotic patients with type 1 HRS.


METHODS
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.
Mulkay
J P
JP
Department of Gastroenterology, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Louis
H
H
Donckier
V
V
Bourgeois
N
N
Adler
M
M
Deviere
J
J
Le Moine
O
O
D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013152:Splanchnic Circulation / Q000187:drug effects; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D003404:Creatinine