Division of Gastroenterology and Hepatology Northwestern University Feinberg School of Medicine Chicago IL Division of Gastroenterology and Hepatology Transplant InstituteHenry Ford Hospital Detroit MI Department of Transplantation Mayo Clinic Jacksonville FL Department of Medicine, Division of Gastroenterology and Hepatology Weill Cornell Medicine New York NY Hepatology and Research South Denver Gastroenterology Englewood CO Department of Transplant Nephrology Henry Ford Health System Detroit MI Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology Padua University Hospital Padua Italy University of Texas Health San Antonio, Texas Liver Institute San Antonio TX Department of Internal Medicine and Surgery David Geffen School of Medicine at University of California Los Angeles Los Angeles CA.
Liver Transpl. 2021 Aug;27(8):1191-1202. doi: 10.1002/lt.26072. Epub 2021 Jul 14.
Acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]-AKI) is a severe and often fatal complication of end-stage liver disease. The goals of treatment are to reverse renal failure and prolong survival in patients who are critically ill. However, interventions have limited efficacy, and mortality rates remain high. In the United States, the mainstay of pharmacologic therapy consists of the off-label use of vasoconstrictive agents in combination with plasma expanders, a strategy that produces modest effects. Liver transplantation is the ultimate solution but is only an option in a minority of patients because contraindications to transplantation are common and organ availability is limited. Renal replacement therapy is a temporary option but is known to confer an extremely poor short-term prognosis in patients with HRS-AKI and at best serves as a bridge to liver transplantation for the minority of patients who are transplantation candidates. The high mortality rate associated with HRS-AKI in the United States is a reflection of the suboptimal standard of care. Improved therapeutic options to treat HRS-AKI are sought. Terlipressin is a drug approved in Europe for treatment of HRS-AKI and supported by recommendations for first-line therapy by some liver societies and experts around the world. This review article will discuss the substantial unmet medical need associated with HRS-AKI and the potential benefits if terlipressin was approved in the United States.
肝硬化（肝肾综合征 [HRS]-AKI）背景下的急性肾损伤 (AKI) 是终末期肝病的一种严重且常致命的并发症。治疗的目标是逆转肾衰竭并延长病危患者的生存时间。然而，干预措施的疗效有限，死亡率仍然很高。在美国，药物治疗的主要方法是使用血管收缩剂与血浆扩容剂联合治疗，这种策略仅产生适度的效果。肝移植是最终的解决方案，但由于移植的禁忌症很常见且器官供应有限，只有少数患者有此选择。肾脏替代疗法是一种临时选择，但在肝肾综合征 - AKI 患者中已知预后极差，对于那些有移植资格的患者，它最多只能作为肝移植的桥梁。美国肝肾综合征 - AKI 死亡率高反映了护理标准的不足。正在寻求改善治疗肝肾综合征 - AKI 的治疗选择。特利加压素是一种在欧洲批准用于治疗肝肾综合征 - AKI 的药物，得到了一些肝脏学会和世界各地专家的一线治疗建议的支持。这篇综述文章将讨论与肝肾综合征 - AKI 相关的大量未满足的医疗需求，如果特利加压素在美国获得批准，可能带来的潜在益处。
