Terlipressin for hepatorenal syndrome: Novel strategies and future perspectives

Type 1 hepatorenal syndrome (HRS) is a functional renal failure that often occurs in patients with cirrhosis and ascites. Type 1 HRS develops as the consequence of a severe reduction of effective circulating volume due to both extreme splanchnic arterial vasodilatation and reduction of cardiac output. Several pilot studies and two randomized control studies have shown that terlipressin plus albumin improves renal function in patients with type 1 HRS. Terlipressin plus albumin can also improve short-term survival in these patients. Terlipressin was most commonly given in intravenous boluses starting from an initial dose of 0.5-1 mg every 4 h to 3 mg every 4 h in case of nonresponse. While there is evidence that terlipressin alone may be less effective than terlipressin combined with intravenous albumin in improving renal function in patients with type 1 HRS, the best way to use terlipressin in these patients is still under evaluation. In particular, some preliminary data show that terli...