Long-term treatment of hepatorenal syndrome as a bridge to liver transplantation.
OBJECTIVE
Terlipressin plus albumin is first-line treatment for hepatorenal syndrome (HRS). Therapy lasts from a few days to two weeks, whereas the efficacy and safety of long-term administration remain unsettled.


METHODS
We describe our experience of prolonged terlipressin and albumin treatment as a bridge to liver transplantation in three patients with cirrhosis and recurrent HRS.


RESULTS
The length of treatment ranged from 62 days to eight months. Attempts to suspend terlipressin or to switch treatment to midodrine plus octreotide were consistently associated with a deterioration of serum creatinine and oliguria. No major side-effects were observed. All patients were transplanted, but two died from peri-operative complications.


CONCLUSIONS
These clinical cases suggest that long-term terlipressin administration in selected patients with recurrent HRS awaiting liver transplantation may represent an option to prevent irreversible renal failure and the need for dialysis until an organ becomes available.
Caraceni
Paolo
P
Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Italy. paolo.caraceni@unibo.it
Santi
Luca
L
Mirici
Federica
F
Montanari
Giancarlo
G
Bevilacqua
Vittoria
V
Pinna
Antonio Daniele
AD
Bernardi
Mauro
M
D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006530:Hepatorenal Syndrome / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D016031:Liver Transplantation; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D000418:Albumins; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D003404:Creatinine