Abstract:
Objectives: Terlipressin improves renal function in hepatorenal syndrome (HRS) is
a known fact. However the reason for lack of its long-term survival benefits despite
improvement in renal function remains unclear. The aim of this study was to analyze
the survival benefits of terlipressin in HRS and to address the issue of non-responder
state to terlipressin.
Materials and Methods: Electronic databases and relevant articles were searched for all
types of studies related to HRS and use of terlipressin in HRS. Reduction in all-cause
mortality rate was the primary outcome measure. Reduction in mortality rate due to
HRS and other causes of death were also analyzed.
Results: With total 377 patients analyzed from eight eligible studies; terlipressin reduced
all-cause mortality rate by 15% (Risk Difference: -0.15%, 95% CI:-0.26 to -0.03). Reduction
in the mortality rate due to HRS at three months was 9% (Risk Difference:-0.09%, 95%
CI:-0.18 to 0.00).
Conclusion: Terlipressin has long term survival benefits perhaps at least up to three
months but only with HRS as a cause of death not for other causes of death. Benefits and
role of antioxidants like N- Acetylcysteine (NAC) in non-responder patients’ needs to
be studied further. Long-term use of low dose terlipressin (<4mg/d) plus albumin and
addition of antioxidant NAC to this regimen may help in improving both HRS reversal
rate and survival rate in non-responders to terlipressin.
