Premium
Response to Terlipressin and Albumin Is Associated With Improved Liver Transplant Outcomes in Patients With Hepatorenal Syndrome
Author(s) -
Piano Salvatore,
Gambino Carmine,
Vettore Elia,
Calvino Valeria,
To Marta,
Boccagni Patrizia,
Gringeri Enrico,
Germani Giacomo,
Burra Patrizia,
Cillo Umberto,
Angeli Paolo
Publication year - 2021
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.31529
Subject(s) - terlipressin , hepatorenal syndrome , medicine , cirrhosis , gastroenterology , liver transplantation , albumin , liver disease , kidney disease , acute kidney injury , renal replacement therapy , transplantation
Background and Aims Although terlipressin and albumin are effective at treating acute kidney injury‐hepatorenal syndrome (AKI‐HRS), liver transplantation (LT) is the best treatment. However, it is unclear if an effective treatment with terlipressin and albumin improves post‐LT outcomes in these patients. The aim of this study was to evaluate the impact of response to treatment with terlipressin and albumin on posttransplant outcomes in patients with AKI‐HRS. Approach and Results We analyzed two cohorts of patients with cirrhosis listed for LT between 2012 and 2016: 82 patients who developed AKI‐HRS before LT and were treated with terlipressin and albumin and 259 patients without AKI‐HRS who received transplants during the study period (control group). After LT, patients were followed up until discharge, every month for the first 3 months, and every 3 months thereafter. Of the patients, 43 (52%) responded to terlipressin and albumin. Responders had a better 30‐day transplant‐free survival (60% vs. 33%, P = 0.006), longer LT waiting list time (37 vs. 17 days, P = 0.041), and lower Model for End‐Stage Liver Disease score at the time of LT (23 vs. 29, P = 0.007). Among patients with AKI‐HRS receiving transplant, nonresponders required renal replacement therapy (RRT) more frequently than responders (20% vs. 0%, P = 0.024). Nonresponders had a significantly higher incidence of chronic kidney disease (CKD) at 1 year after LT than responders (65% vs. 31%, P = 0.019). In multivariate analysis, nonresponse to terlipressin and albumin was found to be an independent predictor for CKD at 1 year after LT (subdistribution hazard ratio [SHR] = 2.76, P = 0.001), whereas responders did not have an increased risk (SHR = 1.53, P = 0.210). Conclusions In patients with AKI‐HRS, response to terlipressin and albumin reduces the need for RRT after LT and reduces the risk of CKD at 1 year after LT.