Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2

Hepatorenal syndrome (HRS) is known for poor prognosis. HRS type 1 is characterized by rapid loss of renal function, while chronic ascites and more moderately elevated renal parameters are characteristic of HRS type 2. While effect of terlipressin/albumin treatment is well established in type 1, there is less knowledge to support its effectiveness in chronic HRS.

The author Marc Nguyen-Tat and colleagues conducted a study titled “Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2” published in the United European Gastroenterology Journal. The summary of this study is below:

Objective:

To investigate the effectiveness of terlipressin/albumin treatment in HRS type 2 patients with

Method:

It is an observational study including patients who experienced the first episode of HRS between April 2013 and February 2016. Relevant laboratory and clinical parameters were recorded and patients were followed.

Findings:

As compare to other randomized trials, this study found a lower response rate for the effectiveness of terlipressin treatment in HRS type 2 patients. The study reports that in LTx-eligible patients, terlipressin treatment act as a bridge to transplant. On the other hand, the authors concluded that terlipressin therapy might not be justified in non-LTx candidates. It is suggested to conduct a prediction of response in HRS type 2 patients before starting with the treatment. The study reports that neither clinical nor laboratory variables are found to be associated with treatment response except for a trend toward higher baseline serum creatinine concentrations. Additionally,  terlipressin response was also found to be independently associated with improved overall survival (OS).

Limitation:

The is chances of bias results as it was an observatory study without a control group. Between the study period of 2013 – 2016, the definition and classification of renal failure in patients with liver cirrhosis have been evolved but this study is conducted on German guidelines on the management of patients with ascites, HRS, and SBP published in 2011. Therefore, authors acknowledge future studies based on recent guidelines.

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