Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2

Abstract

Background Hepatorenal syndrome (HRS) is associated with a poor prognosis. In HRS type 1, loss of renal function is rapidly progressive, while HRS type 2 is characterised by chronic ascites and more moderately elevated renal parameters. While treatment with terlipressin/albumin is well established in type 1, its effectiveness in chronic HRS is less clear. Objective The aim of this study was to evaluate the effectiveness of terlipressin/albumin treatment in patients with HRS type 2. Methods All patients with a first episode of HRS between April 2013 and February 2016 were included in this observational study. Relevant clinical and laboratory parameters were recorded and patients were followed. Results A total of 106 patients with HRS were included. With terlipressin therapy reversal of HRS types 1 and 2 was achieved in 48% and 46% of patients ( p = 0.84) with relapse rates of 8% vs 50% ( p = 0.001). Overall survival (OS) and survival free of liver transplantation (LTx) were similar in HRS types 1 and 2 ( p = 0.69; p = 0.64). In multivariate analysis response to treatment was independently associated with better OS in HRS type 2, in addition to established risk factors such as lower Model for End-Stage Liver Disease score, absence of hepatic encephalopathy and eligibility for LTx. Conclusion A terlipressin treatment course seems to be justified in selected patients with HRS type 2, especially in countries and settings with long transplant waiting lists. In addition treatment response might also help to identify HRS type 2 patients with a more favourable outcome.

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

“…Albumin is of benefit in patients with sepsis owing to its scavenging, anti-oxidant as well as endothelial stabilizing effect apart from its additional benefit of volume expansion. 117 …”

“…For prevention of HRS-AKI and HRS-CKD, albumin should be administered at a dose of 8g for every litre removed when large volume paracentesis (>5L) is carried out. 35 , 45 , 117 …”

Frequency of Hepatorenal Syndrome Among Patients With Cirrhosis and Outcome After Treatment

“…No definitive curative medical treatment has so far been worked out [ 10 ]. Patients with HRS should be treated by supportive measures (blood pressure support and antibiotics), and hemofiltration should only be given if recovery of liver function is likely, either spontaneously or following liver transplantation [ 11 ]. Studies have been conducted regarding treatment; however, convincing data are awaited.…”

High expression of a vascular stricture‐related marker is predictive of an early response to tolvaptan, and a low fractional excretion of sodium is predictive of a poor long‐term survival after tolvaptan administration for liver cirrhosis

“…1 Several other approaches, including using the widely accepted synthetic arginine vasopressin (AVP) analog terlipressin followed by albumin, are effective against hepato-renal syndrome (HRS) types 1 and 2. 2,3 Terlipressin has a high affinity for V1 receptors, among which V1a receptors are located on vascular smooth muscle cells showing vasoconstriction. However, terlipressin also shows V2 receptor binding affinity.…”

“…However, the combination of spironolactone and furosemide showed unfavorable effects, such as intravascular volume depletion, renal effective arterial blood volume (EABV) reduction followed by renal functional deterioration and hyponatremia 1 . Several other approaches, including using the widely accepted synthetic arginine vasopressin (AVP) analog terlipressin followed by albumin, are effective against hepato‐renal syndrome (HRS) types 1 and 2 2,3 . Terlipressin has a high affinity for V1 receptors, among which V1a receptors are located on vascular smooth muscle cells showing vasoconstriction.…”