HRS-AKI - Controversies in terlipressin and transplantation

Q: If there is a high chance that a patient with hepatorenal syndrome-acute kidney injury (HRS-AKI) will get a liver transplant, vasoconstrictors like terlipressin should not be used.

A) True

B) False

Answer: B

Previously, it has been suggested that a positive response to vasoconstrictors is associated with a reduction in serum creatinine in patients with HRS-AKI, thereby lowering the Model for End-stage Liver Disease (MELD) score and potentially leading to patients being excluded from consideration for definitive treatment of HRS-AKI, i.e., liver transplantation. New studies have shown that a positive response to vasoconstrictors in HRS-AKI is associated with improved transplant-free survival days, even if there is a longer wait time for liver transplantation. Also, it lowers the risk of post-transplant chronic kidney disease.

Some programs have adopted a strategy of locking the MELD score before vasoconstrictor therapy in the acute phase.

$transplantation

#hepatology

#nephrology

References:

1. Piano S, Gambino C, Vettore E, et al. Response to Terlipressin and Albumin Is Associated With Improved Liver Transplant Outcomes in Patients With Hepatorenal Syndrome. Hepatology 2021; 73:1909.

2. Reddy KR, Weinberg EM, Gonzalez SA, et al. Safety and efficacy of continuous terlipressin infusion in HRS-AKI in a transplant population. Liver Transpl 2024; 30:1026.

3. Przybyszewski EM, Wilechansky RM, McLean Diaz P, et al. Controversies in terlipressin and transplantation in the United States: How do we MELD the two? Liver Transpl 2024; 30:753.