Medical Treatment of Hepatorenal Syndrome - AASLD

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Background (II)• Synthetic 12-aminoacid peptideH• Pro-drug, with pharmacologic activityof its ownGlyGlyGlyGlyGlyCysCysTyrTyrPhePhe• Constrictive activity via V1-receptors• vascular & extravascular smooth musclecellsGlyGlyProLysLysCysCysAsnAsnGlnGln• Splanchnic vasoconstriction↓ portal flow↓ portal pressureH 2 NTerlipressin• Systemic vasoconstriction↑ effective blood volume↓ renin and angiotensin renal vasodilatation improvement in serum creatinine
SummaryEndpoint Terlipressin Placebo P-valueAll patients N = 56 (%) N = 56 (%)Treatment success day 14 14 (25) 7 (12.5) 0.093HRS reversal 19 (33.9) 7 (12.5) 0.008Received > 3 days Rx N = 36 N = 39Treatment success day 14 14 (38.9) 7 (17.9) 0.046HRS reversal 19 (52.8) 7 (17.9) 0.002
Page 1 and 2: Thomas D. Boyer, MDHepatorenal Synd
Page 3 and 4: Conflicts of interest• Member adv
Page 5 and 6: Pathogenesis of Ascites in Cirrhosi
Page 7 and 8: 7060504030252015105Neurohumoral Sys
Page 9 and 10: Type and Frequency of Injury inAcut
Page 11: Workup of Renal Dysfunction in Pati
Page 14 and 15: Hepatorenal syndromeAdditional Crit
Page 16 and 17: Type 1 HRS Is Associated WithVery P
Page 18 and 19: Who Develops HRS?•Cirrhotic patie
Page 20 and 21: Prevention of HRS
Page 22 and 23: Antibiotic Prophylaxis in VaricealB
Page 24 and 25: Prostaglandin Inhibition andEffects
Page 26 and 27: Treatment of HRS General• Stop al
Page 28 and 29: Site of Action of CurrentTherapies
Page 30 and 31: TIPS and HRSGut 47:166; 2000
Page 32 and 33: Treatment of HRS:Pharmacologic Ther
Page 36 and 37: Reversal of HRS40HRS Reversal (%)30
Page 38 and 39: Survival DistributionFunction1.00.9
Page 40 and 41: Adverse EventsTerlipressinN=56Place
Page 42 and 43: Impact of OLTx on RenalGlomerular f
Page 44 and 45: HRS conclusions continued• Exclus

Medical Treatment of Hepatorenal Syndrome - AASLD

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