Massive ascites and hepatorenal syndrome （HRS） are frequent complications of liver cirrhosis. Thus, effective therapy is of great clinical importance. This concise review provides an update of recent advances and ne...Massive ascites and hepatorenal syndrome （HRS） are frequent complications of liver cirrhosis. Thus, effective therapy is of great clinical importance. This concise review provides an update of recent advances and new developments. Therapeutic paracentesis can be safely performed even in patients with severe coagulopathy. Selected patients with a refractory or recurrent ascites are good candidates for non-surgical portosysternic shunts （TIPS） and may have a survival benefit and improvement of quality of life. Novel pharmaceutical agents mobilizing free water （aquaretics） are currently under test for the therapeutic potential in patients with ascites. Prophylaxis of hepatorenal syndrome in patients with spontaneous bacterial peritonitis is recommended and should be considered in patients with alcoholic hepatitis. Liver transplantation is the best therapeutic option with long-term survival benefit for patients with HRS. To bridge the time until transplantation, TIPS or Terlipressin and albumin are good options. Albumin dialysis can not be recommended outside prospective trials.展开更多
Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not bee...Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and cir-culatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cir-rhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neuro-hormonal systems. Primarily the sympathetic nervoussystem and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged ac-tivation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal per-fusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to re-verse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.展开更多
Hepatorenal syndrome(HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality.A new definition has been recently recommended by the International Club of Ascites,according to...Hepatorenal syndrome(HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality.A new definition has been recently recommended by the International Club of Ascites,according to which HRS diagnosis relies in serum creatinine changes instead that on a fixed high value.Moreover,new data on urinary biomarkers has been recently published.In this sense,the use of urinary neutrophil gelatinase-associated lipocalin seems useful to identify patients with acute tubular necrosis and should be employed in the diagnostic algorithm.Treatment with terlipressin and albumin is the current standard of care.Recent data show that terlipressin in intravenous continuous infusion is better tolerated than intravenous boluses and has the same efficacy.Terlipressin is effective in reversing HRS in only 40%-50% of patients.Serum bilirubin and creatinine levels along with the increase in blood pressure and the presence of systemic inflammatory response syndrome have been identified as predictors of response.Clearly,there is a need for further research in novel treatments.Other treatments have been assessed such as noradrenaline,dopamine,transjugular intrahepatic portosystemic shunt,renal and liver replacement therapy,etc.Among all of them,liver transplant is the only curative option and should be considered in all patients.HRS can be prevented with volume expansion with albumin during spontaneous bacterial peritonitis and after post large volume paracentesis,and with antibiotic prophylaxis in patients with advanced cirrhosis and low proteins in the ascitic fluid.This manuscript reviews the recent advances in the diagnosis and management of this life-threatening condition.展开更多
Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertens...Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.展开更多
Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We i...Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We investigated the pulmonary and systemic hemodynamic effects of the first terlipressin dose(2 mg) in 7 cirrhotic patients with PH presenting with variceal bleeding(n=4) or hepatorenal syndrome(n=3).Terlipressin decreased pulmonary vascular resistance(158.8±8.9 vs 186.5±13.9 dynes sec cm-5 ;P=0.003) together with an increase in systemic vascular resistance(2143± 126 vs 1643±126 dynes sec cm-5 ;P<0.001).Terlipressin should be the vasoconstrictor treatment of choice when patients present with variceal bleeding or HRS.展开更多
BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of t...BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.展开更多
Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is ...Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.展开更多
To the editor:We read with great interest the article entitled "Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats" by Ulmer et al.[1]...To the editor:We read with great interest the article entitled "Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats" by Ulmer et al.[1].The aim of this study was to analyse the impact of terlipressin ver-展开更多
To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terli...To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terlipressin reduces the portal flow.Consequently,it may mitigate the extent of bowel congestion following portal vein clamping.By decreasing portal hyperperfusion and hypertension,it protects the graft from further injury and improves renal blood flow.展开更多
Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjec...Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.展开更多
Background:Observational studies suggest that hepatorenal syndrome(HRS)patients who receive pharmacological therapy before orthotopic liver transplantation display a post-transplant outcome similar to those without HR...Background:Observational studies suggest that hepatorenal syndrome(HRS)patients who receive pharmacological therapy before orthotopic liver transplantation display a post-transplant outcome similar to those without HRS.The aim of this study was to comprehensively compare and rank the pharmacological therapies for HRS.Methods:We reviewed PubMed,Elsevier,Medline,and the Cochrane Central Register of Controlled Trials(CENTRAL)for studies that were published between 1 January 1999 and 24 February 2018.The primary endpoint was reversal of HRS.The secondary endpoints were the changes in serum creatinine(Scr)and serum sodium.We evaluated the different therapeutic strategies using network meta-analysis on the basis of Bayesian methodology.Results:The study included 24 articles with 1,419 participants evaluating seven different therapeutic strategies for HRS.The most effective treatments to induce reversal of HRS were terlipressin plus albumin,noradrenaline plus albumin,and terlipressin,which had a surface under the cumulative ranking curve(SUCRA)of 0.086,0.151,and 0.451,respectively.The top two treatments for decreasing Scr were dopamine plus furosemide plus albumin(rank probability:0.620)and terlipressin plus albumin(rank probability:0.570).For increasing serum sodium,the optimal treatment was octreotide plus midodrine plus albumin(rank probability:0.800),followed by terlipressin plus albumin(rank probability:0.544).Conclusions:Terlipressin plus albumin and dopamine plus furosemide plus albumin should be prioritized for decreasing Scr in HRS,and octreotide plus midodrine plus albumin was the most effective at increasing serum sodium.Terlipressin plus albumin showed a comprehensive effect in both decreasing Scr and increasing serum sodium.展开更多
Background:Excessive portal pressure after massive hepatectomy can cause hepatic sinusoidal injury and have deleterious impacts on hepatic functional recovery,contributing to developing post-hepatectomy liver failure....Background:Excessive portal pressure after massive hepatectomy can cause hepatic sinusoidal injury and have deleterious impacts on hepatic functional recovery,contributing to developing post-hepatectomy liver failure.This study aimed to assess the effects of splanchnic vasoactive agents on hepatic functional recovery and regeneration while clarifying the underlying mechanism,using a 70%hepatectomy porcine model.Methods:Eighteen pigs undergoing 70%hepatectomy were involved in this study and divided into three groups:control(n=6),terlipressin(n=6),and octreotide(n=6).Terlipressin(0.5 mg)and octreotide(0.2 mg)were administered 3 times a day for each group with the first dose starting just before surgery until the 7th postoperative day,at which time the surviving pigs were sacrificed.During the period,portal pressure,liver weight,biochemical analysis,histological injury score,and molecular markers were evaluated and compared between groups.Results:The 7-day survival rates in the octreotide,terlipressin,and control groups were 100%,83.3%,and 66.7%,respectively.The portal pressures decreased in both terlipressin and octreotide groups than the control group at 30 minutes,1 hour and 6 hours after hepatectomy.The amount of regeneration measured by liver weight to body weight ratio at the time of sacrifice in the terlipressin group was smaller than that in the control group(117%vs.129%,P=0.03).Serum aspartate aminotransferase(AST)and total bilirubin levels at 1 and 6 hours after hepatectomy and prothrombin time/international normalized ratio(PT/INR)at 6 hours after hepatectomy were significantly improved in the terlipressin and octreotide groups compared to the control group.Serum endothelin-1(ET-1)was significantly lower in the terlipressin group than that in the control group 6 hours after hepatectomy(P<0.01).The histological injury score in the control group was significantly higher than that in the terlipressin group on the 7th postoperative day(P<0.01).Conclusions:Splanchnic vasoactive agents,such as terlipressin and octreotide,could effectively decrease portal pressure and attenuate liver injury after massive hepatectomy.展开更多
Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleed...Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.展开更多
Hepatorenal syndrome is not an uncommon life-threatening complication arising from liver cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at impr...Hepatorenal syndrome is not an uncommon life-threatening complication arising from liver cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at improving earlier diagnosis and treatment. Liver transplantation remains the only definitive treatment for hepatorenal syndrome. Due to the scarcity of liver grafts, many patients die waiting. This review focuses on the different strategies to bridge patients to liver transplantation and to improve the postoperative outcome.展开更多
文摘Massive ascites and hepatorenal syndrome （HRS） are frequent complications of liver cirrhosis. Thus, effective therapy is of great clinical importance. This concise review provides an update of recent advances and new developments. Therapeutic paracentesis can be safely performed even in patients with severe coagulopathy. Selected patients with a refractory or recurrent ascites are good candidates for non-surgical portosysternic shunts （TIPS） and may have a survival benefit and improvement of quality of life. Novel pharmaceutical agents mobilizing free water （aquaretics） are currently under test for the therapeutic potential in patients with ascites. Prophylaxis of hepatorenal syndrome in patients with spontaneous bacterial peritonitis is recommended and should be considered in patients with alcoholic hepatitis. Liver transplantation is the best therapeutic option with long-term survival benefit for patients with HRS. To bridge the time until transplantation, TIPS or Terlipressin and albumin are good options. Albumin dialysis can not be recommended outside prospective trials.
文摘Hepatorenal syndrome (HRS) is a reversible form of functional renal failure that occurs with advanced hepatic cirrhosis and liver failure. Despite mounting research in HRS, its etiology and medical therapy has not been resolved. HRS encompasses 2 distinct types. Type 1 is characterized by the rapid development of renal failure that occurs within 2 wk and involves a doubling of initial serum creatinine. Type 2 has a more insidious onset and is often associated with ascites. Animal studies have shown that both forms, in particular type 1 HRS, are often precipitated by bacterial infections and cir-culatory changes. The prognosis for HRS remains very poor. Type 1 and 2 both have an expected survival time of 2 wk and 6 mo, respectively. Progression of liver cir-rhosis and the resultant portal hypertension leads to the pooling of blood in the splanchnic vascular bed. The ensuing hyperdynamic circulation causes an ineffective circulatory volume which subsequently activates neuro-hormonal systems. Primarily the sympathetic nervoussystem and the renin angiotensin system are activated, which, in the early stages of HRS, maintain adequate circulation. Both advanced cirrhosis and prolonged ac-tivation of neurohormonal mechanisms result in fatal complications. Locally produced nitric oxide may have the potential to induce a deleterious vasodilatory effect on the splanchnic circulation. Currently medical therapy is aimed at reducing splanchnic vasodilation to resolve the ineffective circulation and maintain good renal per-fusion pressure. Terlipressin, a vasopressin analogue, has shown potential benefit in the treatment of HRS. It prolongs both survival time and has the ability to re-verse HRS in the majority of patients. In this review we aim to focus on the pathogenesis of HRS and its treatment with terlipressin vs other drugs.
文摘Hepatorenal syndrome(HRS) is a manifestation of extreme circulatory dysfunction and entails high morbidity and mortality.A new definition has been recently recommended by the International Club of Ascites,according to which HRS diagnosis relies in serum creatinine changes instead that on a fixed high value.Moreover,new data on urinary biomarkers has been recently published.In this sense,the use of urinary neutrophil gelatinase-associated lipocalin seems useful to identify patients with acute tubular necrosis and should be employed in the diagnostic algorithm.Treatment with terlipressin and albumin is the current standard of care.Recent data show that terlipressin in intravenous continuous infusion is better tolerated than intravenous boluses and has the same efficacy.Terlipressin is effective in reversing HRS in only 40%-50% of patients.Serum bilirubin and creatinine levels along with the increase in blood pressure and the presence of systemic inflammatory response syndrome have been identified as predictors of response.Clearly,there is a need for further research in novel treatments.Other treatments have been assessed such as noradrenaline,dopamine,transjugular intrahepatic portosystemic shunt,renal and liver replacement therapy,etc.Among all of them,liver transplant is the only curative option and should be considered in all patients.HRS can be prevented with volume expansion with albumin during spontaneous bacterial peritonitis and after post large volume paracentesis,and with antibiotic prophylaxis in patients with advanced cirrhosis and low proteins in the ascitic fluid.This manuscript reviews the recent advances in the diagnosis and management of this life-threatening condition.
文摘Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.
文摘Terlipressin has been shown to improve both pulmonary and systemic hemodynamics in stable cirrhotic patients with pulmonary hypertension,whereas other vasoconstrictors may cause pulmonary pressures to deteriorate We investigated the pulmonary and systemic hemodynamic effects of the first terlipressin dose(2 mg) in 7 cirrhotic patients with PH presenting with variceal bleeding(n=4) or hepatorenal syndrome(n=3).Terlipressin decreased pulmonary vascular resistance(158.8±8.9 vs 186.5±13.9 dynes sec cm-5 ;P=0.003) together with an increase in systemic vascular resistance(2143± 126 vs 1643±126 dynes sec cm-5 ;P<0.001).Terlipressin should be the vasoconstrictor treatment of choice when patients present with variceal bleeding or HRS.
文摘BACKGROUND: Post-hepatectomy liver failure as a result of insufficient liver remnant is a feared complication in liver surgery. Efforts have been made to find new strategies to support liver regeneration. The aim of this study was to investigate the effects of terlipressin versus splenectomy on postoperative liver function and liver regeneration in rats undergoing 70%partial hepatectomy. METHODS: Seventy-two male Wistar rats were randomly assigned into three groups(n=24 in each group): 70% partial hepatectomy as control(PHC), 70% partial hepatectomy with splenectomy(PHS) or 70% partial hepatectomy with a micropump for terlipressin administration(PHT). Eight rats in each group were sacrificed on postoperative day(POD) 1,3 and 7. To assess liver regeneration, immunohistochemical analysis of liver tissue using bromodeoxyuridine(BrdU) and Ki-67 labeling was performed. Portal venous pressure, serum concentrations of creatinine, urea, albumin, bilirubin and prothrombin time as well as liver-, body-weight and their ratio were determined on POD 1, 3 and 7.RESULTS: The liver-, body-weight and their ratio were not statistically different among the groups. On POD 1, 3 and 7 portal venous pressure in the intervention groups(PHT:8.13 ±1.55, 10.38±1.30, 6.25±0.89 cm H2O and PHS: 7.50±0.93,8.88 ±2.42, 5.75±1.04 cm H2O) was lower compared to the control group(PHC: 8.63±2.06, 10.50±2.45, 6.50±2.67 cmH2O). Hepatocyte proliferation in the intervention groups was delayed, especially after splenectomy on POD 1(Brd U: PHS vs PHC, 20.85% ±13.05% vs 28.11%±10.10%; Ki-67, 20.14%±14.10% vs 23.96% ±11.69%). However, none of the differences were statistically significant.CONCLUSIONS: Neither the administration of terlipressin nor splenectomy improved liver regeneration after 70% partial hepatectomy in rats. Further studies assessing the regulation of portal venous pressure as well as extended hepatectomy animal models and liver function tests will help to further investigate mechanisms of liver regeneration.
文摘Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.
文摘To the editor:We read with great interest the article entitled "Comparative study of the effects of terlipressin versus splenectomy on liver regeneration after partial hepatectomy in rats" by Ulmer et al.[1].The aim of this study was to analyse the impact of terlipressin ver-
文摘To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terlipressin reduces the portal flow.Consequently,it may mitigate the extent of bowel congestion following portal vein clamping.By decreasing portal hyperperfusion and hypertension,it protects the graft from further injury and improves renal blood flow.
文摘Objective To observe the therapeutic effects of intraperitoneal injection of antibiotics,intravenous injection of terlipressin,and combined treatment of coloclysis and plasma exchange on hepatic failure(HF),the subjects included 494 inpatient cases of hepatic failure who were treated in Department of Infectious Diseases,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China from 1997 to2008.Methods The patients that met the inclusion criteria were divided into intraperitoneal antibiotic injection group,intravenous terlipressin injection group,coloclysis group,plasma exchange group,combination group of coloclysis and plasma exchange in terms of treatment given and a control group was set up for each of the treatment group.In the intraperitoneal injection group,the prognosis and changes in clinical manifestations were observed in HF patients complicated with spontaneous peritonitis(SBP).In terlipressin injection group,HF patients complicated with hepatorenal syndrome(HRS) were observed for prognosis and changes in serum creatinine.In the combination group,the improvement in serum total bilirubin and prothrombin activity were observed.Results Two weeks after intraperitoneal injection of antibiotics,the ease ratios of abdominal pain,pressure pain and rebound tenderness were 87.64%,82.02%and 82.02%in the intraperitoneal injection group,respectively and the volume of ascites obviously decreased in 69 patients(77.53%).The survival rate in intraperitoneal injection group was significantly higher than in control group(P = 0.004).Four to eight days after the intravenous injection of terlipressin,the survival rate and the rate of serum creatinine decline of the treatment group were significantly higher than those in the control group(P = 0.003,P = 0.000).After 4 weeks of treatment,the ratio of clinical symptoms improvement(acratia,anorexia,abdominal distension,constipation) in coloclysis group were60.27%,57.53%,91.78%and 94.52%,in plasma exchange group were 71.83%,69.44%,75%and 72.22%,and in combination group were 82.14%,79.46%,92.85%and 95.54%.The serum total bilirubin was decreased and the prothrombin activity increased and the differences were statistically significant as compared with control group(P= 0.000).Conclusions The intraperitoneal injection of antibiotics,intravenous injection of terlipressin and combined treatment of coloclysis and plasma exchange were all effective for the treatment of HF and its complications.
基金supported by the National Natural Science Foundation of China[No.H0517/81560132 and No.81970583]the Supporting Project for the Foregoers of Main Disciplines of Jiangxi Province[No.20162BCB22023].
文摘Background:Observational studies suggest that hepatorenal syndrome(HRS)patients who receive pharmacological therapy before orthotopic liver transplantation display a post-transplant outcome similar to those without HRS.The aim of this study was to comprehensively compare and rank the pharmacological therapies for HRS.Methods:We reviewed PubMed,Elsevier,Medline,and the Cochrane Central Register of Controlled Trials(CENTRAL)for studies that were published between 1 January 1999 and 24 February 2018.The primary endpoint was reversal of HRS.The secondary endpoints were the changes in serum creatinine(Scr)and serum sodium.We evaluated the different therapeutic strategies using network meta-analysis on the basis of Bayesian methodology.Results:The study included 24 articles with 1,419 participants evaluating seven different therapeutic strategies for HRS.The most effective treatments to induce reversal of HRS were terlipressin plus albumin,noradrenaline plus albumin,and terlipressin,which had a surface under the cumulative ranking curve(SUCRA)of 0.086,0.151,and 0.451,respectively.The top two treatments for decreasing Scr were dopamine plus furosemide plus albumin(rank probability:0.620)and terlipressin plus albumin(rank probability:0.570).For increasing serum sodium,the optimal treatment was octreotide plus midodrine plus albumin(rank probability:0.800),followed by terlipressin plus albumin(rank probability:0.544).Conclusions:Terlipressin plus albumin and dopamine plus furosemide plus albumin should be prioritized for decreasing Scr in HRS,and octreotide plus midodrine plus albumin was the most effective at increasing serum sodium.Terlipressin plus albumin showed a comprehensive effect in both decreasing Scr and increasing serum sodium.
基金This investigation was supported by the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT,Ministry of Education,Science and Technology)(No.NRF-2017R1A2B2005754).
文摘Background:Excessive portal pressure after massive hepatectomy can cause hepatic sinusoidal injury and have deleterious impacts on hepatic functional recovery,contributing to developing post-hepatectomy liver failure.This study aimed to assess the effects of splanchnic vasoactive agents on hepatic functional recovery and regeneration while clarifying the underlying mechanism,using a 70%hepatectomy porcine model.Methods:Eighteen pigs undergoing 70%hepatectomy were involved in this study and divided into three groups:control(n=6),terlipressin(n=6),and octreotide(n=6).Terlipressin(0.5 mg)and octreotide(0.2 mg)were administered 3 times a day for each group with the first dose starting just before surgery until the 7th postoperative day,at which time the surviving pigs were sacrificed.During the period,portal pressure,liver weight,biochemical analysis,histological injury score,and molecular markers were evaluated and compared between groups.Results:The 7-day survival rates in the octreotide,terlipressin,and control groups were 100%,83.3%,and 66.7%,respectively.The portal pressures decreased in both terlipressin and octreotide groups than the control group at 30 minutes,1 hour and 6 hours after hepatectomy.The amount of regeneration measured by liver weight to body weight ratio at the time of sacrifice in the terlipressin group was smaller than that in the control group(117%vs.129%,P=0.03).Serum aspartate aminotransferase(AST)and total bilirubin levels at 1 and 6 hours after hepatectomy and prothrombin time/international normalized ratio(PT/INR)at 6 hours after hepatectomy were significantly improved in the terlipressin and octreotide groups compared to the control group.Serum endothelin-1(ET-1)was significantly lower in the terlipressin group than that in the control group 6 hours after hepatectomy(P<0.01).The histological injury score in the control group was significantly higher than that in the terlipressin group on the 7th postoperative day(P<0.01).Conclusions:Splanchnic vasoactive agents,such as terlipressin and octreotide,could effectively decrease portal pressure and attenuate liver injury after massive hepatectomy.
文摘Variceal bleeding is one of the important signs of decompensation in patients with cirrhosis of the liver.It is always a medical emergency and sometimes results in death.Every year many patients die due to acute bleeding worldwide.The outcome depends on bleeding and its complications as well as the severity of the underlying liver disease.Careful volume resuscitation,administration of antibiotics and vasoactive drugs,and early endoscopic therapy prevent rebleeding and death.People living in rural areas are first referred to a district hospital from the Upazila health complex for any medical emergency.So,commencing the resuscitation process as well as administration of the vasoactive drug(terlipressin)at the first attending hospital before being referred to a higher center will decrease the mortality in patients presenting with acute variceal bleeding.
文摘Hepatorenal syndrome is not an uncommon life-threatening complication arising from liver cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at improving earlier diagnosis and treatment. Liver transplantation remains the only definitive treatment for hepatorenal syndrome. Due to the scarcity of liver grafts, many patients die waiting. This review focuses on the different strategies to bridge patients to liver transplantation and to improve the postoperative outcome.
