Long-term outcome of patients treated with terlipressin for types 1 and 2 hepatorenal syndrome.
BACKGROUND
Studies suggest that terlipressin is effective in the treatment of hepatorenal syndrome (HRS). However, factors predicting response to therapy and the long-term outcome of patients have not been defined.


METHODS
We reviewed all patients from our institution treated with terlipressin between July 1, 2001 and December 31, 2005 for HRS. Follow up continued until June 30, 2006. HRS was defined according to the International Ascites Club. The following data were retrieved: age, gender, etiology of liver disease, Child-Pugh score, HRS precipitant, therapy duration, creatinine at day 0 and end of treatment, adverse events, and patient outcome.


RESULTS
Sixty-nine patients were included. Forty-nine episodes (71%) of HRS were type 1, and 20 episodes (29%) type 2. Forty-one (59.4%) patients responded to terlipressin. Two variables predicted renal function improvement: type 1 HRS and age. Twenty-one (30.4%) patients survived; 17 (81%) had type 1 HRS while four (19%) had type 2 HRS (P = 0.27). The only factor predicting transplant-free survival was type 1 HRS. No patients with type 2 HRS survived without transplantation (P = 0.02).


CONCLUSIONS
The only factor predicting transplant-free survival following terlipressin therapy is the presence of type 1 HRS. Therefore, it is difficult to justify the use of this drug in patients with type 2 HRS who are not liver transplant candidates.
Testro
Adam G
AG
Department of Gastroenterology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, Australia.
Wongseelashote
Sarah
S
Angus
Peter W
PW
Gow
Paul J
PJ
D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016031:Liver Transplantation; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D000077585:Terlipressin; D013997:Time Factors; D016896:Treatment Outcome