Abstract
Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a severe complication of cirrhosis that carries a poor prognosis. The recent Food and Drug Administration approval of terlipressin has substantial implications for managing HRS-AKI and liver allocation in the United States. Terlipressin has been available in Europe for over a decade, and several countries have adapted policy changes such as Model for End-Stage Liver Disease (MELD) score “lock” for HRS-AKI. In this article, we outline the European experience with terlipressin use and explore the question of whether terlipressin treatment for HRS-AKI should qualify for the MELD score “lock” in the United States in those who respond to therapy. Arguments for the MELD lock include protecting waitlist priority for terlipressin responders or partial responders who may miss offers due to MELD reduction in the terlipressin treatment window. Arguments against MELD lock include the fact that terlipressin may produce a durable response and improve overall survival and that equitable access to terlipressin is not guaranteed due to cost and availability. We subsequently discuss the proposed next steps for studying terlipressin implementation in the United States. A successful approach will require the involvement of all major stakeholders and the mobilization of our transplant community to spearhead research in this area.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 753-759 |
| Number of pages | 7 |
| Journal | Liver Transplantation |
| Volume | 30 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2024 |
Funding
Andrew S. Allegretti consults for Mallinckrodt, Ocelot Bio, Motric Bio, and Sequana Medical. Lisa B. VanWagner consults for Eurofines, Enanta, Intercept, Gerson Lehrman Group, NGM, Novo Nordisk, Numares, Slingshot Insights, and Antheneum Partners. She received grants from W.L. Gore & Associates. She has served as an expert witness. Giuseppe Cullaro consults for Ocelot Bio and Retro. He received an AASLD Clinical, Translational, and Outcomes Research Award. Josh Levitsky advises and is on the speakers\u2019 bureau for Mallinckrodt. He advises Eurofins. He is on the speakers\u2019 bureau for Takeda. Pere Gin\u00E8s consults for and received grants from Gilead. He consults for or advises and received grants from Grifols and Ferring Pharmaceuticals. He consults for or advises Intercept, Martin Pharmaceuticals, Promethera, and Sequana. He consults for RallyBio, SeaBeLife, MSD, Ocelot Bio, Behring, Roche Diagnostics International, and Boehringer Ingelheim. He is on the speakers\u2019 bureau for Pfizer. He received grants from Mallinckrodt. Salvatore Piano consults for Plasma Protein Therapeutics Association, Boehringer Ingelheim, and Resolution Therapeutics. He is on the speakers\u2019 bureau for Grifols and Medscape. He advises Mallinckrodt. The remaining authors have no conflicts to report. Giuseppe Cullaro has received funding through NIDDK DK131278. Lisa B. VanWagner received grants from the NIH (NIDDK, NIA, NHLBI-R56 HL155093). Andrew S. Allegretti is funded by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (K23 DK128567).
ASJC Scopus subject areas
- Surgery
- Hepatology
- Transplantation