Practice guidance for the use of terlipressin for liver cirrhosis–related complications

Abstract

Background: Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis–related complications has been recognized during recent years. This article aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis–related complications. Methods: Hepatobiliary Study Group of the Chinese Society of Gastroenterology of the Chinese Medical Association and Hepatology Committee of the Chinese Research Hospital Association have invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts’ clinical experiences. Results: Overall, 10 major guidance statements regarding efficacy and safety of terlipressin in liver cirrhosis were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction, and bacterial infections and in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin-related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. Conclusion: The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis–related complications.

Terlipressin-Induced Skin Necrosis While Managing Hepatorenal Syndrome: A Rare Case Report From North India

“…The discontinuation of terlipressin is crucial in the treatment of skin necrosis [ 8 ] as it can prevent further progression of the condition and promote healing. Withholding the drug allows the skin to recover and promotes the restoration of blood flow to the affected area.…”

Navigating Complex Challenges: Preoperative Assessment and Surgical Strategies for Liver Resection in Patients with Fibrosis or Cirrhosis

“…The addition of a nonselective beta-blocker should also be considered to help reduce portal pressure and the risk of variceal bleeding [ 72 ]. Terlipressin, a vasopressin analog, has shown efficacy in decreasing intraoperative portal pressure, blood loss, and the number of blood transfusions [ 73 ]. It has also been shown to decrease postoperative portal pressure in cirrhotic patients undergoing liver resection [ 73 ].…”

“…Terlipressin, a vasopressin analog, has shown efficacy in decreasing intraoperative portal pressure, blood loss, and the number of blood transfusions [ 73 ]. It has also been shown to decrease postoperative portal pressure in cirrhotic patients undergoing liver resection [ 73 ]. Despite this, there is not enough evidence supporting the preoperative use of Terlipressin for the prevention of complications in patients undergoing liver resection [ 73 ].…”

Acute Kidney Injury in Liver Cirrhosis

“…In September 2022, terlipressin received FDA approval for the treatment of adults with HRS-AKI, making it the first approved treatment for this indication in the United States [77]. However, terlipressin has been used widely outside the US for over 30 years and is considered standard of care in many centers in Europe and around the world [78]. Terlipressin is a 12-amino acid peptide that is derived from lysine vasopressin and works as a vasopressin receptor agonist with increased selectivity for V1 and V2 receptors [79].…”