Long-term outcome of patients treated with terlipressin for types 1 and 2 hepatorenal syndrome.

BACKGROUND: Studies suggest that terlipressin is effective in the treatment of hepatorenal syndrome (HRS). However, factors predicting response to therapy and the long-term outcome of patients have not been defined.

METHODS: We reviewed all patients from our institution treated with terlipressin between July 1, 2001 and December 31, 2005 for HRS. Follow up continued until June 30, 2006. HRS was defined according to the International Ascites Club. The following data were retrieved: age, gender, etiology of liver disease, Child-Pugh score, HRS precipitant, therapy duration, creatinine at day 0 and end of treatment, adverse events, and patient outcome.

RESULTS: Sixty-nine patients were included. Forty-nine episodes (71%) of HRS were type 1, and 20 episodes (29%) type 2. Forty-one (59.4%) patients responded to terlipressin. Two variables predicted renal function improvement: type 1 HRS and age. Twenty-one (30.4%) patients survived; 17 (81%) had type 1 HRS while four (19%) had type 2 HRS (P = 0.27). The only factor predicting transplant-free survival was type 1 HRS. No patients with type 2 HRS survived without transplantation (P = 0.02).

CONCLUSIONS: The only factor predicting transplant-free survival following terlipressin therapy is the presence of type 1 HRS. Therefore, it is difficult to justify the use of this drug in patients with type 2 HRS who are not liver transplant candidates.