Vasopressin analogues associated with
albumin improve renal function in
hepatorenal syndrome (HRS). The current study was aimed at assessing the efficacy of the treatment, predictive factors of response, recurrence of HRS, and survival after
therapy. Twenty-one consecutive patients with HRS (16 with type 1 HRS, 5 with type 2 HRS) received
terlipressin (0.5-2 mg/4 hours intravenously) until complete response was achieved (serum
creatinine level < 1.5 mg/dL) or for 15 days; 13 patients received intravenous
albumin together with
terlipressin. Twelve of the 21 patients (57%) showed complete response.
Albumin administration was the only predictive factor of complete response (77% in patients receiving
terlipressin and
albumin vs. 25% in those receiving
terlipressin alone, P =.03). Treatment with
terlipressin and
albumin was associated with a remarkable decrease in serum
creatinine level, increase in arterial pressure, and suppression of the
renin-
aldosterone system. By contrast, no significant changes in these parameters were found in patients treated with
terlipressin alone. Only 1 patient showed ischemic adverse effects. Recurrence of HRS occurred in 17% of patients with complete response. The occurrence of complete response was associated with an improved survival. In conclusion,
terlipressin therapy reverses HRS in a high proportion of patients. Recurrence rate
after treatment withdrawal is uncommon.
Albumin appears to improve markedly the beneficial effects of
terlipressin.