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Title of Journal: Dig Dis Sci

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Abbravation: Digestive Diseases and Sciences

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Springer US

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DOI

10.1002/ptr.803

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1573-2568

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Targeting an Early and Substantial Increase in Mea

Authors: Geetha Maddukuri Cindy X Cai Satish Munigala Farnaz Mohammadi Zhiwei Zhang
Publish Date: 2013/10/22
Volume: 59, Issue: 2, Pages: 471-481
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Abstract

Appreciation of the central role for arterial vasodilatation in the pathogenesis of hepatorenal syndrome HRS has led to routine use of vasoconstrictors in combination with albumin as a medical therapy for HRS Various vasoconstrictors have been explored but the optimal approach for such therapies has not yet been establishedA total of 59 patients with type 1 HRS who received a combination therapy of vasoconstrictors and albumin were enrolled into a retrospective cohort study Subjects having a substantial increase of more than 10 mmHg in MAP by day 3 after initiation of therapy were categorized as MAP responders and the rest as MAP nonresponders In addition five patients were enrolled into a prospective pilot study in which a titration protocol of vasoconstrictors was followed to achieve early goaldirected therapy EGDTMAP responders achieved significantly higher incidence of treatment success or total response less requirement of dialysis and more incidence of liver transplantation More importantly this response is associated with better shortterm and longterm overall survival as well as transplantfree survival The effectiveness of such an approach was further confirmed in the pilot study which followed an EGDT protocolGeetha Maddukuri was supported by an educational fund from the US Department of Veteran Affairs We are grateful to the Saint Louis University hepatology team including Drs Alex Befeler Brent NeuschwanderTetri Lliana Bouneva Adrian Di Bisceglie and Bruce Bacon for their support during the study period

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