ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2026
United States Experience With Terlipressin in Hepatorenal Syndrome: Response, Mortality, and Transplant Outcomes - Results From the HRS Harmony Consortium.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Nonintensive Care Unit Norepinephrine as an Alternative to Terlipressin in Hepatorenal Syndrome-Acute Kidney Injury.Gastro hep advances · 2026Article
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48 authors.
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Abstract
BACKGROUND &
aimsTerlipressin became the first United States Food and Drug Administration-approved therapy for hepatorenal syndrome-acute kidney injury in 2022. We present its initial experience at 16 United States academic medical centers.
methodsConsecutive patients with hepatorenal syndrome-acute kidney injury treated with terlipressin were followed for 90 days. Patients met standard criteria (conforming to United States Food and Drug Administration labeling guidance) or extended criteria (presence of ≥1 United States Food and Drug Administration warning/limitation: acute-on-chronic liver failure grade 3, serum creatinine >5 mg/dL, or hypoxia at initiation). Primary outcomes were overall response (complete or partial response per guidelines) and hepatorenal syndrome reversal (terminal serum creatinine <1.5 mg/dL plus ≥0.3 mg/dL reduction). Fine and Gray models with liver transplant as a competing risk were used to assess 90-day mortality.
resultsA total of 243 patients were analyzed. 40.5% died and 27.2% received liver transplant by 90 days. Overall response occurred in 55.1% and hepatorenal syndrome reversal in 30.9%. Forty-nine percent met extended criteria, most commonly due to acute-on-chronic liver failure grade 3 (45%). Standard criteria was associated with higher overall response (62.9% vs 47.1%; P = .019) and fewer adverse events leading to terlipressin discontinuation (12.1% vs 22.7%; P = .044). In adjusted analysis, hepatorenal syndrome reversal was not associated with reduced mortality, but overall response was (subdistribution hazard ratio, 0.57; 95% confidence interval, 0.38-0.86; P = .01).
conclusionsThis United States multicenter study provides insights into real-world use of terlipressin for hepatorenal syndrome-acute kidney injury. Terlipressin was frequently used in patients with acute-on-chronic liver failure grade 3. Adherence to United States Food and Drug Administration labeling criteria was associated with superior efficacy and safety. The significant association between overall response and reduced mortality underscores its potential as a clinically relevant endpoint for future studies.
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