Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study

Richard Moreau, Francois Durand, Thierry Poynard, Christian Duhamel, Jean-Paul Cervoni, Philippe Ichaï, Armand Abergel, Chantal Halimi, Mathieu Pauwels, Jean-Pierre Bronowicki, Emile Giostra, Cathy Fleurot, Danielle Gurnot, Olivier Nouel, Philippe Renard, Michel Rivoal, Pierre Blanc, Dimitri Coumaros, Sylvie Ducloux, Stephane Levy, Alexandre Pariente, Jean-Marc Perarnau, Jean Roche, Myriam Scribe-Outtas, Dominique Valla, Brigitte Bernard, Didier Samuel, Joël Butel, Antoine Hadengue, Andrzej Platek, Didier Lebrec, Jean-Francois Cadranel
Gastroenterology 2002, 122 (4): 923-30

BACKGROUND & AIMS: Type 1 hepatorenal syndrome (HRS) is a severe complication of cirrhosis associated with a short median survival time (<2 weeks). Although the administration of terlipressin improves renal function, its effect on survival is unknown. This study investigated predictive factors of survival in patients with type 1 HRS treated with terlipressin.

METHODS: Ninety-nine patients with type 1 HRS treated with terlipressin in 24 centers were retrospectively studied. Terlipressin-induced improved renal function was defined as a decrease in serum creatinine value to <130 micromol/L or a decrease of at least 20% at the end of treatment.

RESULTS: At inclusion, the Child-Pugh score was 11.8 +/- 1.6 (mean +/- SD). Terlipressin (3.2 +/- 1.3 mg/day) was administered for 11 +/- 12 days. Renal function improved in 58% of patients (serum creatinine decreased by 46% +/- 17% from 272 +/- 114 micromol/L). Median survival time was 21 days. Survival rate was 40% at 1 month. Multivariate analysis showed that improved renal function and Child-Pugh score < or =11 at inclusion were independent predictive factors of survival (P < 0.0001 and 0.02, respectively). Thirteen patients underwent liver transplantation (92 +/- 95 days after HRS onset), 10 of whom had received terlipressin and had had improved renal function.

CONCLUSIONS: This retrospective uncontrolled study shows that in patients with type 1 HRS, terlipressin-induced improved renal function is associated with an increase in survival. Thus, a randomized trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.

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