Terlipressin treatment in patients with hepatorenal syndrome

ABSRTACTIntroduction and Objective: Hepatorenal Syndrome(HRS) developes on a background ofacute or chronic hepatic disease, without a cause which can be shown as clinic, laboratory orhistological, characterize by an acute functional renal failure, a complication of cirrhosiswhich has a high mortality. Arterial vasodilation of the splanchnic vascular bed,vasoconstriction in secondary renal circulation and with the hemostatic activation ofvasoconstrictor system decreased effective blood flow that is the mechanism responsible forpathogenesis. Vasopressin analogues(terlipressin, ornipressin) cause vasoconstriction of thesplanchnic and systemic circulation, improve effective arterial blood flow and attenuateactivation of the endogenous vasoconstrictor system(renin-angiotensin and sympatheticnervous system) and thereby increase renal perfusion and glomerular filtration rate. In thisstudy, effects of treatment with terlipressin on survival and risk factors for death of patientswith HRS was searched.Material and Method: In this study, from January 2000 to July 2008, 52 patients(19 type IHRS patients and 33 type II HRS patients) diagnosed as HRS treated with terlipressin areevaluated.Findings: Treatment withTerlipressin and after the treatment serum sodium levels weredetermined to be significantly increased (p=0,030). Patients' survival rate % 33,3, mediansurvival time 19 days. Patients' survival rate at 30 days was %25,4. During the treatment andafter treatment liver transplantation was performed in 7 patients.During the treatment, between both patients who were treated with hemodialysis and whowere not treated with hemodialysis survival rate were significantly (p= 0.002) different. Whenmost effective risk factors for death determined as using contrast agents (p=0,006, HR=2,8),hemodialysis (p=0,025 HR=2,8); the risk of death decreased with increasing terlipressintreatment time was determined (p=0,002 HR=0,89).Conclusion: Using contrast agents, the necessity for hemodialysis and increasing terlipressintreatment time are the most effective risk factors on death of the HRS. The definitivetreatment for hepatorenal syndrome is liver transplantation. However until the time of liver transplantation for extending the survival especially terlipressin is a good alternative to thosewho were waiting for liver transplantation.