47. Midodrine and albumin versus albumin alone for the secondary prophylaxis of hepatorenal syndrome

Abstract

Background and Aims: Hepatorenal syndrome (HRS) in patient with cirrhosis is an indication for liver transplantation. It has high recurrence rate with high short term mortality. Midodrine, an oral adrenergic vasoconstrictor, has shown promising results in treatment of HRS. We aim to compare midodrine and albumin versus albumin alone for the secondary prophylaxis of HRS. Methods: Open labelled, non randomised, pilot study. Patients with diagnosis of HRS and treated with terlipressin and albumin were recruited after recovery. Patients were given midodrine daily (15 mg) and injection albumin 20 gms weekly in group A (Gp-A) and injection albumin 20 gm weekly with no midodrine in group B (Gp-B). Primary end point was recurrence of HRS at two month. Secondary end point was to assess the need of recurrent ascites tap in two month period. Results: Total of 34 patients were enrolled with Gp-A, n = 20 and Gp-B, n = 14. There was no significant difference between the groups (Gp-A vs. Gp-B) in terms of age (51 ± 11 vs. 47 ± 13 yr), MELD (26 ± 4 vs. 25 ± 3.3), CTP score (11 ± 0.8 vs. 11 ± 1) and serum creatinine at inclusion (1.3 ± 0.2 mg/dl vs. 1.1 ± 0.3 mg/dl). At two month nine patients (68%) in Gp-B and four patients (20%) in Gp-A develop HRS (p = 0.01). Majority of patients in Gp-B had recurrence of HRS within one month (n = 7). Mean number of ascites tap were significantly higher in Gp-B compared to Gp-A (2.5 ± 0.5 vs. 1.9 ± 0.5) over 2 months period. There was no signicant difference between serum albumin level at 2 month between the group (Gp-A 3.0 ± 0.1 vs. Gp-B 2.9 ± 0.1, p = ns). Conclusions: Midodrine along with albumin is helpful in the secondary prophylaxis of HRS and significantly reduces the number of ascites tap compared to albumin alone. The authors have none to declare.