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 1 HRS, Patients: Twelve consecutive patients fulfilling HRS criteria of the International Ascites Club mere included in the study. Median plasma creatinine and sodium, urine volume and sodium before treatment were 3,4 mg% (2,5-4,0); 127 mEq/l (124-130), 500 ml/24h (100-1031) and 7 mEq/24h (1-17), 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% (1.3-2.1) 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 ( I 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 1 HRS, However, it does not cure the underlying disease and therefore, may only he considered as a bridge to a definitive treatment as liver transplantation.