Effects of terlipressin and somatostatin on liver and thorax blood volumes in patients with cirrhosis

Background: Variceal bleeding in cirrhosis can cause liver ischaemia and deteriorate the hyperdynamic state; thus, the effects of vasoconstrictor therapy on liver blood volume (LBV) and thorax blood volume (ThBV) are important. Aim: To evaluate and compare the effects of terlipressin and somatostatin on LBV and ThBV in stable patients with cirrhosis and portal hypertension. Methods: Twenty patients were studied (Child-Pugh class A/B/C: 5/8/7). The radioactivities in the liver region (LRR) and the thorax region (ThRR) by single-head gamma camera technique, as indicators of LBV and ThBV, respectively, and systemic haemodynamics were measured at baseline and after intravenous infusion of 2 mg of terlipressin (n = 10) or somatostatin 250 mg/h after an initial bolus of 250 mg (n = 10). Results: LRR and ThRR decreased significantly with increasing severity of cirrhosis. Thirty minutes after terlipressin infusion, LRR and ThRR increased by 7.8 +/- 4.4% (NS) and 14 +/- 5.3% (P = 0.01) compared with baseline values; the increase in ThRR was significantly related to the increase in LRR (r = 0.682, P = 0.03). In contrast, somatostatin reduced LRR and ThRR by 13.3 +/- 6.5% (P = 0.07) and 1 +/- 4% (NS) respectively. LRR and ThRR increased significantly in the terlipressin group compared with the somatostatin group (P = 0.01 and P = 0.02 respectively). Terlipressin reduced cardiac output and heart rate (both P = 0.01) and increased the mean arterial pressure (MAP) and systemic vascular resistance (P = 0.009 and P = 0.002 respectively); MAP decreased after somatostatin infusion (P = 0.03). Conclusions: Terlipressin, but not somatostatin, maintains LBV, increases ThBV and improves the hyperdynamic state in cirrhosis. These effects can be beneficial in variceal bleeding, particularly in patients with advanced liver disease.