Hepatorenal syndrome: Is it truly the end of the road?

Abstract

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 micromolL 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 (64%) 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 ≤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.