Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Division of Hepatology, Department of Medicine, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA.
Liver Transpl. 2024 Oct 1;30(10):1026-1038. doi: 10.1097/LVT.0000000000000399. Epub 2024 May 22.
Hepatorenal syndrome-acute kidney injury (HRS-AKI) is associated with significant morbidity and mortality. While liver transplantation is the definitive treatment, continuous terlipressin infusion for HRS-AKI may provide benefit and, as such, was assessed in a population composed of candidates for liver transplant (LT). Fifty hospitalized LT-eligible patients with HRS-AKI received a single bolus followed by continuous terlipressin infusion. Acute-on-chronic liver failure grade 3, serum creatinine (SCr)>5.0 mg/dL, or Model for End-Stage Liver Disease (MELD) ≥35 were exclusions. Fifty hospitalized patients who received midodrine and octreotide or norepinephrine for HRS-AKI served as a historical comparator cohort. Complete response (CR) was defined as a ≥30% decrease in SCr with end-of-treatment (EOT) SCr≤1.5, partial response as a ≥30% decrease in SCr with EOT SCr>1.5, and nonresponse as a <30% decrease in SCr. CR rate was significantly higher in the terlipressin cohort compared to the historical cohort (64% vs. 16%, p <0.001). Survival, while numerically higher in those who received terlipressin, was statistically similar (D30: 94% vs. 82%, p =0.12; D90: 78% vs. 68%, p =0.37). Renal replacement therapy (RRT) was more common among terlipressin NR than CR and PR (70% vs. 3% vs. 13%, p < 0.001). EOT MELD and SCr were significantly lower within terlipressin cohort (MELD: 19 vs. 25, SCr: 1.4 vs. 2.1 mg/dL, p <0.001). Sixteen of 40 terlipressin-treated patients received LT-alone (terlipressin CR in 10/16). One patient on terlipressin had a hypoxic respiratory failure that responded to diuretics; one possibly had drug-related rash. With continuous terlipressin infusion, a CR rate of 64% was observed with a favorable safety profile. Terlipressin use was associated with lower EOT MELD and SCr than the historical midodrine and octreotide/norepinephrine cohort; LT-alone was accomplished in a high proportion of complete terlipressin responders.
肝肾综合征-急性肾损伤（HRS-AKI）与显著的发病率和死亡率相关。虽然肝移植是明确的治疗方法，但持续特利加压素输注治疗 HRS-AKI 可能有益，因此，在一组肝移植（LT）候选者中进行了评估。50 名住院的符合 LT 标准的 HRS-AKI 患者接受了单次推注，随后进行持续特利加压素输注。排除急性慢性肝衰竭 3 级、血清肌酐（SCr）>5.0mg/dL 或终末期肝病模型（MELD）≥35。50 名住院患者接受米多君和奥曲肽或去甲肾上腺素治疗 HRS-AKI，作为历史对照队列。完全缓解（CR）定义为治疗结束时（EOT）SCr≤1.5，SCr 较基线降低≥30%，部分缓解定义为 EOT 时 SCr>1.5，SCr 较基线降低≥30%，无反应定义为 SCr 降低<30%。与历史队列相比，特利加压素组的 CR 率显著更高（64% vs. 16%，p<0.001）。尽管接受特利加压素治疗的患者生存率更高，但统计学上无显著差异（D30：94% vs. 82%，p=0.12；D90：78% vs. 68%，p=0.37）。在特利加压素无反应者中，肾替代治疗（RRT）更为常见（NR 为 70%，CR 和 PR 为 3%和 13%，p<0.001）。特利加压素组的 EOT MELD 和 SCr 显著降低（MELD：19 比 25，SCr：1.4 比 2.1mg/dL，p<0.001）。40 名接受特利加压素治疗的患者中有 16 名接受了单独 LT（特利加压素 CR 者 10/16）。一名接受特利加压素治疗的患者发生缺氧性呼吸衰竭，对利尿剂有反应；一名患者可能有药物相关皮疹。持续特利加压素输注时，观察到 64%的 CR 率，安全性良好。与历史米多君和奥曲肽/去甲肾上腺素队列相比，特利加压素的 EOT MELD 和 SCr 较低；在完全特利加压素反应者中，单独 LT 的比例较高。
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