Long-term terlipressin administration improves renal function in cirrhotic patients with type 1 hepatorenal syndrome : a pilot study

Background: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis. Recently, ornipressin, a potent splanchnic vasoconstrictor, was reported to improve renal function in patients with HRS. However, this treatment is associated with a high incidence of vascular complications. Terlipressin is thought to be as effective as ornipressin with less systemic complications. Aims : To evaluate the effectiveness and safety of terlipressin administration in cirrhotic patients with type I HRS. Patients : Twelve consecutive patients fulfilling HRS criteria of the International Ascites Club were included in the study. Median plasma creatinine and sodium, urine volume and sodium before treatment were 3,4 mg% 12,5-4,01 ; 127 mEqA 1124-1301, 500 ml/24h 1100-1031) and 7 mEq/24h fl-171. Methods : Terlipressin was administered iv 2 mg bid in 8 patients and tid in 4 others for at least one week and up to 2 months. Results : After one week of treatment median plasma creatinine decreased to 1.8 mg% 11.3-2.11 together with an increase in urine volume, sodium excretion, creatinine and free-water clearance. Three patients underwent successful liver transplantation with a near normal renal function after 34, 36 and 111 days. The 9 other patients died during follow-up (4 from sepsis, 2 from digestive bleeding and 3 from liver failure). No ischaemic complications were encountered during the treatment. Conclusions : Long-term terlipressin administration is safe and effective to control type I HRS. However, it does not cure the underlying disease and therefore, may only be considered as a bridge to a definitive treatment as liver transplantation.