Review
Copyright ©The Author(s) 2016.
World J Hepatol. Aug 28, 2016; 8(24): 999-1011
Published online Aug 28, 2016. doi: 10.4254/wjh.v8.i24.999
Table 1 The role of terlipressin and albumin in hepatorenal syndrome-1
Ref.Terlipressin doseAlbuminLengthTerlipressin group: Cr (mg/dL) or Cr Cl (mL/min)Control group: Cr (mg/dL) or Cr Cl (mL/min)30 d survival (terlipressin vs control)Transplant free outcome
Hadengue et al[113]1 mg twice dailyNo2 dCr Cl: 27 ± 4Cr Cl: 15 ± 2N/AN/A
Halimi et al[49]4 mg/dYes7 d (mean)Decline in Cr from 31%-75% from day 0 to day 5N/A13/18 (72%) patient responseN/A
Danalioglu et al[42]2-4 mg/dYes6 dN/AN/A20% vs 0%N/A
Testro et al[54]1 mg every 6 h (max of 8 mg/d)Yes12 dN/AN/A17/49 HRS type 1, 4/20 HRS type 2All transplant free outcomes responded to terlipressin
Sanyal et al[46]1 mg every 6 h (doubled on 4 d if Cr did not < 30%)No (control group received albumin)14 dCr < 1.5 mg/dL (19/59, 33.9%)Cr < 1.5 mg/dL (7/56, 12.5%)N/A42.9% (24/56) vs 37.5% (21/56) in terlipressin vs control group at 180 d
von Kalckreuth et al[47]3.9 mg ± 1.3 mg (responders) vs 3.4 mg ± 1.4 mg (nonresponders)Yes6 ± 4.9 d (responder) vs 8 ± 6.3 d (non-responders)N/AN/AComplete response by day 7 was 52%, while at day 17 it was 84%25/38 (66%) of treatment complete response was achieved
Boyer et al[44]1 mg every 6 hYes6.3 d (mean)Cr: 2.8 mg/dLCr: 3.8 mg/dLN/A34% non-transplanted survival 100% transplant survival at 180 d
Hinz et al[51]2-6 mg/dYesN/AN/AN/A57% of patients (12/21) responded to terlipressin. Age was a negative predictor for treatment responseNo difference seen in mortality between responders and non-responders at 60 d
Heidemann et al[50]26.43 ± 30.86 (total dose for responders) vs 32.11 ± 31.57 (total dose for non-responders)Yes9 d (responders) vs 10.5 d (non-responders)N/AN/AOne month survival was longer in responders vs non-responders (P = 0.048)N/A
Sagi et al[45] (meta-analysis)N/AYesMinimum of 3 d of terlipressinCr must have been < 1.5 mg/dL at treatment endN/AFour trials (n = 223) with RR for reversal in type 1 HRS with terlipressin was 3.66 (95%CI: 2.15-6.23)N/A
Fabrizi et al[48] (meta-analysis)N/AN/AN/AN/AN/AFive trials (n = 243 patients) with pooled OR of HRS reversal was 8.09 (95%CI: 3.52; 18.59)Recovery of renal function occurs in less than 50% of patients with HRS even with terlipressin
Table 2 Comparing outcomes measures between liver transplantation alone vs simultaneous liver kidney transplantation including graft and patient survival as well as need for renal replacement therapy
Ref.No. of LTANo. of SLKTGraft survival (LTA vs SLKT)Patient survival (LTA vs SLKT)Renal dysfunction post 1, 5 and 10 yr (LTA vs SLKT)RRT post-transplantation (LTA vs SLKT)Additional comments
Jeyarajah et al[81]2442 (Cr > 2.0, nationawide)29 (single center) + 414 (nationwide)N/A5 yr survival nationwide (50.4% vs 62.2%)N/AN/AInterestingly, single center study had increased better survival in LTA than SLKT group
Campbell et al[80]5313N/AN/A1 yr (1.4 mg/dL vs 1.5 mg/dL)2% vs 0% (at 12 mo)Adjusting for baseline characteristics, SLKT patients had lower Cr than LTA at 12 mo (P = 0.01)
Ruiz et al[83]80 (all with HRS)98 (22 with HRS and 76 with primary renal disease)1 yr SLKT survival (liver: 76% and kidney: 76%)1 yr survival (66% LTA vs 72% SLKT)N/APost-op dialysis: (89% LTA pts for median of 9 d vs 55% SLKT pts for median 2.5 d)1 yr acute kidney rejection in CLKT was 14% vs 23% in 5 yr LT cohort
Locke et al[84]191371032N/A1 yr survival for pts with ≥ 3 mo RRT: (70.8% LTA vs 84.5% SLKT)N/AN/AEven after matched-control analysis, there was no benefit in SLKT cohort vs LTA cohort outside of aforementioned RRT
Mehrabi et al[85] (literature review)N/A3536Cumulative 5 yr SLKT survival of both organs (60.9%)Cumulative 5 yr survival 42.6%N/AN/AIt is concluded that there is no definitive evidence of better graft/patient survival in SKLT vs LTA
Chava et al[114]N/A395 yr SLKT survival (liver: 73.7% and kidney: 70%)73.7% SLKT patient survival at 5 yrN/AN/A15 surviving patients (53.6%) had mild/moderate kidney dysfunction
Fong et al[82]277415015 yr survival (58.9% LTA vs 65.3%, SLKT, P < 0.001)5 yr survival (62.9% LTA vs 67.4% SLKT, P < 0.001)0% with severe renal dysfunctionN/ALiver graft survival and patient survival was better in SLKT vs LTA group
Martin et al[88] 201266026232715% decreased risk of graft loss with SLKT vs LTA (P = 0.02)N/AN/AN/ASLKT had higher graft survival rates than both KALT and LAKT
Sharma et al[86]2112 (received RRT within 90 d before LT)N/AN/A78% LTA survival at 6 mo (not associated with RRT duration)N/A8.90%Risk for non-recovery increased by 3.6%/day of pre-LT RRT
Catalano et al[89]743710 yr survival (77% LTA vs 80% SLKT, P = 0.85)10 yr survival (79% LTA vs 86% SLKT, P = 0.56)N/AN/AAcute rejection episodes involving the liver were less in SLKT vs LTA