• Yoshiyuki Narahara, Hidenori Kanazawa, Yasuhiko Taki, Yuu Kimura, Masanori Atsukawa, Tamaki Katakura, Hideko Kidokoro, Hirotomo Harimoto, Takeshi Fukuda, Yoko Matsushita, Katsuhisa Nakatsuka, and Choitsu Sakamoto.
• Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan. y-nara@nms.ac.jp
• J. Gastroenterol. Hepatol. 2009 Nov 1; 24 (11): 1791-7.

Background And AimTerlipressin has been shown to be effective in the management of hepatorenal syndrome. However, how terlipressin exerts its effect on the renal artery is unknown. The aim of the present study was to assess the effects of terlipressin on systemic, hepatic and renal hemodynamics in cirrhosis.MethodsTwenty-eight patients with cirrhosis and portal hypertension were studied. Systemic and hepatic hemodynamics, hepatic and renal arterial resistive indices and neurohumoral factors were measured prior to and 30 min after intravenous administration of 1 mg terlipressin (n = 19) or placebo (n = 9).ResultsAfter terlipressin, there were significant increases in both mean arterial pressure (P < 0.001) and systemic vascular resistance (P < 0.001), whereas heart rate (P < 0.001) and cardiac output (P < 0.001) decreased significantly. There was a significant decrease in the hepatic venous pressure gradient (P < 0.001). Portal venous blood flow also decreased significantly (P < 0.001). The mean hepatic arterial velocity increased significantly (P < 0.001). Although there was a significant decrease in the hepatic arterial resistive index (0.72 +/- 0.08 to 0.69 +/- 0.08, P < 0.001) and renal arterial resistive index (0.74 +/- 0.07 to 0.68 +/- 0.07, P < 0.001), portal vascular resistance was unchanged (P = 0.231). Plasma renin activity decreased significantly (P < 0.005), and there was a significant correlation between this decline and the decrease in renal arterial resistive index (r = 0.764, P < 0.005). The effects of terlipressin on systemic, hepatic and renal hemodynamics were observed similarly in patients with and without ascites. Placebo caused no significant effects.ConclusionTerlipressin decreases hepatic and renal arterial resistance in patients with cirrhosis.

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