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Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis

International Urology and Nephrology volume 43, pages 175–184 (2011)Cite this article

Abstract

Background

Hepatorenal syndrome (HRS) is a common complication in patients with cirrhosis or fulminant liver failure. We systematically reviewed the benefits and harms of using terlipressin, a novel vasoconstricting agent in patients with HRS.

Methods

We searched MEDLINE, SCOPUS, and conference proceedings for relevant trials of terlipressin. Results were summarized using the random-effects model.

Results

Eight trials (320 participants) were included. When compared with placebo, terlipressin-treated patients had higher HRS reversal (odds ratio [OR] 7.47, 95% confidence interval [CI] 3.17–17.59), mean arterial pressure (weighted mean difference [WMD] 11.26 mmHg, 95% CI 1.52–21), and urine output. There was a significant increase in ischemic adverse events with terlipressin when compared to placebo. There was mild-to-moderate heterogeneity in these analyses. There was no significant difference between terlipressin and noradrenaline in HRS reversal (OR 1.23, 95% CI, 0.43–3.54), mean arterial pressure, and urine output. Side-effect profile did not differ between terlipressin and noradrenaline.

Conclusion

Terlipressin improves HRS reversal and other surrogate outcome measures compared with placebo, but no significant differences for these outcomes were noted when comparing terlipressin and noradrenaline. Terlipressin is a potential therapeutic option for HRS, but larger trials comparing terlipressin to other widely used vasoconstrictors are warranted.

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Acknowledgment

We would like to thank the authors of the included studies who provided additional study details and Ms. Sandra Bronoff, Cleveland Clinic for her editorial assistance.

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Affiliations

  1. Department of Medicine, Huron Hospital—A Cleveland Clinic Hospital, Cleveland, OH, USA

    Mirela Dobre

  2. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Sevag Demirjian & Sankar D. Navaneethan

  3. Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Ashwini R. Sehgal

Authors
  1. Mirela Dobre
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  2. Sevag Demirjian
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  3. Ashwini R. Sehgal
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  4. Sankar D. Navaneethan
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Correspondence to Mirela Dobre.

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Dobre, M., Demirjian, S., Sehgal, A.R. et al. Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis. Int Urol Nephrol 43, 175–184 (2011). https://doi.org/10.1007/s11255-010-9725-8

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  • DOI: https://doi.org/10.1007/s11255-010-9725-8

Keywords

  • Terlipressin
  • Hepatorenal syndrome
  • Vasoconstrictors