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. 2025 Sep 8:S1542-3565(25)00751-7.
doi: 10.1016/j.cgh.2025.08.031. Online ahead of print.

Real-world Use of Terlipressin in Cirrhosis and Acute Kidney Injury: Frequent Use Beyond Hepatorenal Syndrome

Ann T Ma  1 , Adrià Juanola  2 , Kavish R Patidar  3 , Anna Barone  4 , Simone Incicco  4 , Anand V Kulkarni  5 , Nipun Verma  6 , Christian M Lange  7 , Qing Xie  8 , Carlo Alessandria  9 , Eira Cerda Reyes  10 , Rakhi Maiwall  11 , Jeong Han Kim  12 , Sebastián Marciano  13 , Alberto Queiroz Farias  14 , Claudio Toledo  15 , Silvia Nardelli  16 , Julio D Vorobioff  17 , Juan Pablo Roblero  18 , Thierry Thévenot  19 , Maria Papp  20 , Raoel Maan  21 , Cristina Solé  22 , Jacqueline Cordova-Gallardo  23 , Douglas A Simonetto  24 , Yasser Fouad  25 , Lorenz Balcar  26 , Sarah Raevens  27 , Puria Nabilou  28 , Paolo Caraceni  29 , Manuela Merli  30 , José Presa  31 , Wim Laleman  32 , Aleksander Krag  33 , Tony Bruns  34 , Gustavo Pereira  35 , Angelo Z Mattos  36 , Juan Pablo Arab  37 , Brian Wentworth  38 , Nadia Abdelaaty Abdelkader  39 , Yu Jun Wong  40 , Sung-Eun Kim  41 , Olivier Roux  42 , R Bart Takkenberg  43 , Antonio Galante  44 , Luciana Lofego Goncalves  45 , Nikolaos T Pyrsopoulos  46 , José Luis Pérez Hernández  47 , Sumeet K Asrani  48 , Aldo Torre  49 , Javier Díaz-Ferrer  50 , Eric S Orman  51 , Giovanni Perricone  52 , Adrian Gadano  13 , Vladimir Ivashkin  53 , Eduardo Fassio  54 , Mónica Marino  55 , Victor Vargas  56 , Liane Rabinowich  57 , Pedro Montes  58 , Abdulsemed Mohammed  59 , Enrique Carrera  60 , María Cecilia Cabrera  61 , Marcos Girala  62 , Hrishikesh Samant  63 , Joao Madaleno  64 , W Ray Kim  65 , Carlos Noronha Ferreira  66 , Andrew S Allegretti  67 , Shiv K Sarin  11 , Pere Ginès  2 , Paolo Angeli  4 , Elsa Solà  65 , Salvatore Piano  68 ; International Club of Ascites GLOBAL AKI team
Collaborators, Affiliations
Free article

Real-world Use of Terlipressin in Cirrhosis and Acute Kidney Injury: Frequent Use Beyond Hepatorenal Syndrome

Ann T Ma et al. Clin Gastroenterol Hepatol. .
Free article

Abstract

Background & aims: Terlipressin is indicated to treat hepatorenal syndrome (HRS)-acute kidney injury (AKI) but is likely used outside this primary indication in clinical practice. We aimed to investigate real-world practice patterns on the use of terlipressin in AKI in cirrhosis.

Methods: International prospective study including patients hospitalized for decompensated cirrhosis. This was a subgroup analysis of patients who received terlipressin to treat AKI. Primary outcome was AKI resolution. Secondary outcomes were respiratory failure and 28-day mortality.

Results: Among 1456 patients with AKI, 243 (17%) received terlipressin. Terlipressin was predominantly administered as a continuous infusion (75%). The AKI phenotype was HRS-AKI in 50%, acute tubular necrosis (ATN) in 17%, hypovolemic in 25%, and other in 8%. AKI resolution occurred in 49% of the patients, and was lowest in ATN (29%), followed by HRS-AKI (51%) and hypovolemic (63%). ATN was independently associated with lack of AKI resolution (odds ratio, 2.77; 95% confidence interval, 1.24-6.54; P = .02). De novo respiratory failure occurred in 20% of patients. There were no significant differences in the amount of albumin received nor acute-on-chronic liver failure grade between those who did and did not develop respiratory failure. The presence of pneumonia independently predicted respiratory failure (odds ratio, 7.80; 95% confidence interval, 2.43-26.95; P < .001). Mortality rate at 28 days was 36%; ATN and hospital-acquired AKI independently predicted 28-day mortality.

Conclusions: Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Compared with patients with HRS-AKI, response to terlipressin is significantly lower in patients with ATN, in whom the risks may outweigh the benefits. Respiratory failure is common but does not seem to be driven by the amount of albumin received nor acute-on-chronic liver failure grade.

Keywords: Hepatorenal Syndrome; Mortality; Respiratory Failure; Vasoconstrictor.

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