Use of Peri-operative Terlipressin in Patients with Pre-operative Type 1 Hepatorenal Syndrome in Adult Liver Transplantation – A Randomized Controlled Trial

Dr Chok, Kenneth Siu Ho   (Principal Investigator (PI))

Professor Cheung Tan To   (Co-Investigator)

Dr She Brian Wong Hoi   (Co-Investigator)

Dr Sin Sui Ling   (Co-Investigator)

Dr Dai Jeff   (Co-Investigator)

Dr Lo Kevin   (Co-Investigator)

Dr Fung James Yan Yue   (Co-Investigator)

Dr Ma Ka Wing   (Co-Investigator)

Professor Chan Albert Chi Yan   (Co-Investigator)

Professor Lo Chung Mau   (Co-Investigator)

Dr Wong Cho Lam Tiffany   (Co-Investigator)

30

2016-06-30

2018-12-29

150000

Use of Peri-operative Terlipressin in Patients with Pre-operative Type 1 Hepatorenal Syndrome in Adult Liver Transplantation – A Randomized Controlled Trial

Hepatorenal syndrome, Liver failure, Liver Transplant, Outcomes, Renal failure, Terlipressin

Transplantation,Anaesthesia

201605159005

Seed Fund for Basic Research for New Staff

2015

Completed

Hepatorenal syndrome (HRS) is a functional renal failure which occurs in patients with advanced liver cirrhosis. It generally reflects poor prognosis. It is characterized by a combination of disturbances in circulatory and kidney functions. The key pathogenesis involves splanchnic vasodilatation and intense renal vasoconstriction. The definition of HRS is based on a set of agreed diagnostic criteria by the International Ascites Club published in 2007 and 2015. There were two types of HRS and type I HRS is clinically more important because of high mortality associated with acute renal failure. Many trials have been shown that pharmacological therapy including vasopressin analogues and intravenous albumin can provide short term improvement of renal function in this group of patients. However, potentially long term survival can only be achieved by liver transplantation (LT) and deceased-donor liver transplantation showed favorable long term outcomes in recent studies. In our center, data has shown that LDLT can save lives in these critically ill patients with acceptable risks despite long term renal function is inferior to those non-HRS counterparts. Almost all patients will have normal or near-normal renal function after the treatments before LT. Nonetheless, most of them will have worsened renal function again immediately after the operation. Recent studies suggested that the use of peri-operative terlipressin would reduce the incidence of acute kidney injury post LDLT. In the systemic search, no randomised controlled trial was identified. A study from Egypt showed that intra-operative usage of terlipressin would significantly reduce the incidence of postoperative AKI (24.2% vs. 44.6%, p=0.001) in a retrospective case-controlled manner. Another recent prospective study showed that the use of intraoperative terlipressin resulted in significantly better postoperative renal function and yet no difference in the liver function was observed. Furthermore, the use of terlipressin could lower the dosage of vasoconstrictive drugs during the transplantation. Unfortunately, little data is available for the use of peri-operative terlipressin for those patients with preoperative type-1 HRS. A prospective randomised controlled trial comparing use of peri-operative terlipressin is proposed at our centre. The objectives of the trial are (1) to test the hypothesis that peri-operative terlipressin entails a better postoperative renal function after LT in pre-operative type-1 HRS patients (2) to see whether longer term renal function can be improved in pre-operative HRS patients.