title: The use of terlipressin in cirrhotic patients with refractory ascites and normal renal function: a multicentric study.
abstract: Ascites is a common complication of liver cirrhosis, occurring in more than 50-60% of the patients within 10 years of the diagnosis. In 5-10% of patients, ascites cannot be mobilized, or its early recurrence cannot be prevented by medical treatment. This condition is known as "refractory ascites". The use of terlipressin in cirrhotic patients with refractory ascites and normal renal function has not been evaluated. This prospective study was aimed at evaluating whether terlipressin in addition to standard therapy (diuretics plus albumin) might improve the outcome of refractory ascites in cirrhotic patients without HRS.
  
  
  METHODS
  26 cirrhotic patients with refractory ascites were prospectively enrolled in this study. All the patients had tense (grade 3) ascites, and 10/26 showed also massive peripheral edema. Patients received maximum diuretic treatment plus albumin and terlipressin.
  
  
  RESULTS
  Complete response was seen in 16/26 patients. The higher response to therapy was seen during the 2nd week of treatment. 6 patients showed a decrease of at least two points in the ascites score. No differences in clinical response to treatment were seen according to the etiology of the disease.
  
  
  CONCLUSIONS
  In conclusion, our study shows a synergistic effect of terlipressin vs treatment with albumin plus diuretics in patients with refractory ascites. One could speculate that albumin might enhance the vasoconstrictive response to terlipressin, thus contributing to counterbalance the negative effects of systemic vasodilation, which characterizes the hyperdynamic circulation of cirrhotic patients.
authors.affiliation: Dept. of Internal Medicine, Umberto I Hospital, Nocera Inferiore, Salerno, Italy. basiliofimiani1@tin.it
authors.forename: Basilio
authors.initials: B
authors.lastname: Fimiani
authors.forename: Domenico Della
authors.initials: DD
authors.lastname: Guardia
authors.forename: Claudio
authors.initials: C
authors.lastname: Puoti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Adamo
authors.forename: Olimpia
authors.initials: O
authors.lastname: Cioffi
authors.forename: Anna
authors.initials: A
authors.lastname: Pagano
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Tagliamonte
authors.forename: Antonio
authors.initials: A
authors.lastname: Izzi
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006530:Hepatorenal Syndrome / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000418:Albumins; D004232:Diuretics; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin