Effects of terlipressin on systemic, hepatic and renal hemodynamics in patients with cirrhosis.
OBJECTIVE
Terlipressin has been shown to be effective in the management of hepatorenal syndrome. However, how terlipressin exerts its effect on the renal artery is unknown. The aim of the present study was to assess the effects of terlipressin on systemic, hepatic and renal hemodynamics in cirrhosis.


METHODS
Twenty-eight patients with cirrhosis and portal hypertension were studied. Systemic and hepatic hemodynamics, hepatic and renal arterial resistive indices and neurohumoral factors were measured prior to and 30 min after intravenous administration of 1 mg terlipressin (n = 19) or placebo (n = 9).


RESULTS
After terlipressin, there were significant increases in both mean arterial pressure (P < 0.001) and systemic vascular resistance (P < 0.001), whereas heart rate (P < 0.001) and cardiac output (P < 0.001) decreased significantly. There was a significant decrease in the hepatic venous pressure gradient (P < 0.001). Portal venous blood flow also decreased significantly (P < 0.001). The mean hepatic arterial velocity increased significantly (P < 0.001). Although there was a significant decrease in the hepatic arterial resistive index (0.72 +/- 0.08 to 0.69 +/- 0.08, P < 0.001) and renal arterial resistive index (0.74 +/- 0.07 to 0.68 +/- 0.07, P < 0.001), portal vascular resistance was unchanged (P = 0.231). Plasma renin activity decreased significantly (P < 0.005), and there was a significant correlation between this decline and the decrease in renal arterial resistive index (r = 0.764, P < 0.005). The effects of terlipressin on systemic, hepatic and renal hemodynamics were observed similarly in patients with and without ascites. Placebo caused no significant effects.


CONCLUSIONS
Terlipressin decreases hepatic and renal arterial resistance in patients with cirrhosis.
Narahara
Yoshiyuki
Y
Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan. y-nara@nms.ac.jp
Kanazawa
Hidenori
H
Taki
Yasuhiko
Y
Kimura
Yuu
Y
Atsukawa
Masanori
M
Katakura
Tamaki
T
Kidokoro
Hideko
H
Harimoto
Hirotomo
H
Fukuda
Takeshi
T
Matsushita
Yoko
Y
Nakatsuka
Katsuhisa
K
Sakamoto
Choitsu
C
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006530:Hepatorenal Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007275:Injections, Intravenous; D008102:Liver Circulation / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D008236:Lypressin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000097:blood; D015990:Placebo Effect; D012079:Renal Circulation / Q000187:drug effects*; D000077585:Terlipressin; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D018377:Neurotransmitter Agents; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin