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Case Reports
. 2011 Aug;55(2):491-6.
doi: 10.1016/j.jhep.2011.02.002. Epub 2011 Feb 18.

Continuous Recurrence of Type 1 Hepatorenal Syndrome and Long-Term Treatment With Terlipressin and Albumin: A New Exception to MELD Score in the Allocation System to Liver Transplantation?

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Case Reports

Continuous Recurrence of Type 1 Hepatorenal Syndrome and Long-Term Treatment With Terlipressin and Albumin: A New Exception to MELD Score in the Allocation System to Liver Transplantation?

Salvatore Piano et al. J Hepatol. .
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Abstract

Background & aims: The recurrence of type 1 hepatorenal syndrome has been described in up to 20% of responders to terlipressin and albumin after the discontinuation of the treatment. Subsequent recurrence of type 1 hepatorenal syndrome may require long-term treatment with terlipressin and albumin.

Methods: We describe our experience of long-term administration of terlipressin as a bridge to LT in three patients with cirrhosis and recurrent type 1 hepatorenal syndrome. For all three patients we requested an "early transplant" which is an option recognized in our country to reduce waiting times for liver transplantation.

Results: All three patients were transplanted within 2 months of onset of hepatorenal syndrome. All patients are still alive and none of them have developed chronic kidney disease.

Conclusions: The outcomes of these patients suggest that long-term treatment with terlipressin and albumin is effective and well tolerated in patients with continuous recurrence of type 1 hepatorenal syndrome and, therefore, should be considered an absolute priority criterion in the allocation system for liver transplantation.

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