title: Continuous recurrence of type 1 hepatorenal syndrome and long-term treatment with terlipressin and albumin: a new exception to MELD score in the allocation system to liver transplantation?
abstract: OBJECTIVE
  The recurrence of type 1 hepatorenal syndrome has been described in up to 20% of responders to terlipressin and albumin after the discontinuation of the treatment. Subsequent recurrence of type 1 hepatorenal syndrome may require long-term treatment with terlipressin and albumin.
  
  
  METHODS
  We describe our experience of long-term administration of terlipressin as a bridge to LT in three patients with cirrhosis and recurrent type 1 hepatorenal syndrome. For all three patients we requested an "early transplant" which is an option recognized in our country to reduce waiting times for liver transplantation.
  
  
  RESULTS
  All three patients were transplanted within 2 months of onset of hepatorenal syndrome. All patients are still alive and none of them have developed chronic kidney disease.
  
  
  CONCLUSIONS
  The outcomes of these patients suggest that long-term treatment with terlipressin and albumin is effective and well tolerated in patients with continuous recurrence of type 1 hepatorenal syndrome and, therefore, should be considered an absolute priority criterion in the allocation system for liver transplantation.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.forename: Novella
authors.initials: N
authors.lastname: Boscato
authors.forename: Patrizia
authors.initials: P
authors.lastname: Boccagni
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000418:Albumins / Q000008:administration & dosage*; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D000077585:Terlipressin; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin