Abstract: TH-PO0771
Single-Center Outcomes of Terlipressin in Patients with Hepatorenal Syndrome-AKI
Session Information
- AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ismail, Ibrahim, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Nachman, Patrick H., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Murray, Sean, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Benson, Anna Rebecca, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Safadi, Sami, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background
Terlipressin is FDA-approved therapy for hepatorenal syndrome-acute kidney injury (HRS-AKI). The CONFIRM trial reported verified HRS reversal in 32% of treated patients but no 90-day survival benefit We here report our single-center, real-world terlipressin outcomes.
Methods
Retrospective cohort of all encounters of terlipressin therapy for HRS-AKI at one academic medical center. Exposure was characterized by cumulative dose, number of doses, and duration of treatment. Endpoints mirrored CONFIRM definitions: HRS reversal (any creatinine ≤1.5 mg/dL during treatment), verified HRS reversal (two consecutive values ≤1.5 mg/dL with ≥10-day RRT-free survival), and 90-day mortality. Dose-outcome associations were assessed by Wilcoxon rank-sum tests and univariable logistic regression with cumulative dose modeled per 10-mg increment.
Results
Forty-nine encounters from 45 unique patients were analyzed. Median age was 48.9 years; 57% were female and 88% had alcohol-related cirrhosis; median MELD was 35 and median cumulative terlipressin exposure 10.2 mg. HRS reversal occurred in 40%, verified reversal in 23%, in-hospital death in 23%, liver transplantation in 24%, and RRT initiation in 73%; 90-day mortality was 41% among encounters with ≥90-day follow-up or confirmed death. No exposure metric (cumulative dose, number of doses, duration) was associated with any outcome. Compared with CONFIRM, verified reversal was numerically lower (23% vs 32%), 90-day mortality was lower (41% vs 51%), and RRT use was higher.
Conclusion
In this single-center experience, terlipressin-treated patients with HRS-AKI demonstrated outcomes directionally consistent with - yet lower in efficacy than - the CONFIRM trial, likely reflecting a population with a higher burden of comorbidities. The absence of any dose-response signal suggests outcomes are dominated by underlying disease rather than treatment intensity. Additional studies are needed to define which patients benefit most from terlipressin.
Clinical Outcomes
| Outcome | n / N | Percent |
| HRS reversal | 19 / 48 | 40% |
| Verified HRS reversal | 11 / 48 | 23% |
| In-hospital death | 11 / 48 | 23% |
| 90-day mortality | 18 / 44 | 41% |
| Liver transplant | 12 / 49 | 24% |
| RRT initiation | 36 / 49 | 73% |
| Vasopressor use during admission | 27 / 49 | 55% |
| Respiratory failure after treatment | 10 / 49 | 20% |