Absolute and relative contraindications to terlipressin therapy for hepatorenal syndrome-acute kidney injury (HRS-AKI)

Absolute	Relative
Hypoxia (eg, SpO₂ <90% on room air) or worsening respiratory symptoms History of significant vascular disease Ongoing myocardial, peripheral, or mesenteric ischemia	Serum creatinine >5 mg/dL Acute on chronic liver failure (ACLF) grade 3 (ie, ≥3 organ failures)^[1] Serum bilirubin >10 mg/dL^*

Terlipressin is the preferred vasoconstrictor for the treatment of HRS-AKI. The main reason to use alternative vasoconstrictor therapies such as norepinephrine or midodrine plus octreotide is unavailability of terlipressin. Most patients with HRS-AKI who have absolute or relative contraindications to terlipressin should not receive or would be unlikely to respond to other vasoconstrictors.

* Some experts do not have a bilirubin threshold for withholding terlipressin.

Reference:

Jalan R, Saliba F, Pavesi M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol 2014; 61:1038.

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خرید پکیج

Absolute and relative contraindications to terlipressin therapy for hepatorenal syndrome-acute kidney injury (HRS-AKI)