1. Controversies in terlipressin and transplantation in the United States: How do we MELD the two?
- Author
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Przybyszewski EM, Wilechansky RM, McLean Diaz P, Allegretti AS, VanWagner LB, Cullaro G, Levitsky J, Ginès P, Piano S, Asrani SK, and Patidar KR
- Subjects
- Humans, United States, End Stage Liver Disease surgery, End Stage Liver Disease mortality, End Stage Liver Disease complications, Liver Cirrhosis complications, Liver Cirrhosis surgery, Europe, Patient Selection, Prognosis, Treatment Outcome, Terlipressin therapeutic use, Liver Transplantation standards, Liver Transplantation statistics & numerical data, Liver Transplantation adverse effects, Hepatorenal Syndrome etiology, Hepatorenal Syndrome diagnosis, Waiting Lists mortality, Vasoconstrictor Agents therapeutic use, Acute Kidney Injury etiology, Acute Kidney Injury therapy, Severity of Illness Index
- 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., (Copyright © 2024 American Association for the Study of Liver Diseases.)
- Published
- 2024
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