Safety and efficacy of continuous terlipressin infusion in HRS-AKI in a transplant population.
Rajender K ReddyEthan M WeinbergStevan A GonzalezManhal J IzzyDouglas A SimonettoR Todd FrederickRaymond A RubinZachary FrickerJade Ikahihifo-BenderMaggie HarteSandra GarciaKathryn CampbellAmy OlofsonRyan F RazaviJanelle M JamesHet PatelGrace Kim-LeeSherry WitkiewiczWilliam TobinKhurram JamilPublished in: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (2024)
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.
Keyphrases
- acute kidney injury
- liver failure
- respiratory failure
- cardiac surgery
- low dose
- newly diagnosed
- squamous cell carcinoma
- radiation therapy
- extracorporeal membrane oxygenation
- metabolic syndrome
- emergency department
- drug induced
- mechanical ventilation
- prognostic factors
- acute respiratory distress syndrome
- locally advanced
- smoking cessation
- adverse drug