title: Terlipressin plus hydroxyethyl starch infusion: an effective treatment for hepatorenal syndrome.
abstract: Ornipressin is a vasopressin analogue that can cause potent splanchnic vasoconstriction. It has been shown that, in combination with albumin infusion, ornipressin is able to reverse hepatorenal syndrome. However, its clinical use is limited by possible severe ischaemic complications. In our case, a 47-year-old man received a right hemihepatectomy for cholangiocellular carcinoma. On post-operative day three, he developed hepatorenal syndrome with ascites, peripheral oedema and oliguria (250-500 ml/day). Serum creatinine was increased to 3.5 mg/dl. The patient was treated with terlipressin, another vasopressin analogue with fewer side effects than ornipressin, (1 mg every 4 h intravenously) and hydroxyethyl starch (500 ml/day). Urine output increased to 3000 ml/day, serum creatinine decreased to normal range within 4 days and ascites and oedema disappeared. We hereby report the first case of successful treatment of hepatorenal syndrome with terlipressin and hydroxyethyl starch, which appears to be a safe and effective treatment.
authors.affiliation: Klinik für Allgemein und Transplantationchirurgie, University Hospital Essen, Essen, Germany. fuat.saner@uni-essen.de
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Nils R
authors.initials: NR
authors.lastname: Frühauf
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Schäfers
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery; D004359:Drug Therapy, Combination; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000188:drug therapy*; D000077585:Terlipressin; D014662:Vasoconstrictor Agents
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin