Treatment of Type-1 Hepatorenal Syndrome with Pentoxifylline: A Randomized Placebo Controlled Clinical Trial

• Published in: Annals of hepatology Vol. 17; no. 2; pp. 300 - 306
• Main Authors: Stine, Jonathan G, Wang, Jennifer, Cornella, Scott L, Behm, Brian W, Henry, Zachary, Shah, Neeral L, Caldwell, Stephen H, Northup, Patrick G
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier 01.03.2018
• Subjects: Aged; Albumins - therapeutic use; Cirrhosis; Drug Therapy, Combination; Female; Gastroenterology and Hepatology; Hepatology; Hepatorenal Syndrome - diagnosis; Hepatorenal Syndrome - drug therapy; Hepatorenal Syndrome - etiology; Hepatorenal Syndrome - mortality; Hospital Mortality; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - drug therapy; Liver Cirrhosis - mortality; Liver Transplantation; Male; Middle Aged; Midodrine - therapeutic use; Nephrology; Octreotide - therapeutic use; Patient Admission; Pentoxifylline - adverse effects; Pentoxifylline - therapeutic use; Pilot Projects; Renal failure; Survival; Time Factors; Treatment Outcome; Vasoconstrictor Agents - therapeutic use; Virginia; Virginia; Cirrhosis; Nephrology; Survival; Hepatology; Renal failure; Liver transplantation; Cirrhosis. Liver transplantation. Hepatology. Survival. Renal failure. Nephrology
• ISSN: 1665-2681
• DOI: 10.5604/01.3001.0010.8661

AbstractIntroduction. Type-1 hepatorenal syndrome (HRS-1) portends a poor prognosis in patients with cirrhosis. Currently available medical therapies are largely ineffective, save for liver transplantation. We aimed to determine if pentoxifylline (PTX) therapy in addition to the standard of care of volume expansion with albumin and vasoconstriction with midodrine and octreotide (AMO) is safe and efficacious compared to AMO in HRS-1 treatment. Material and methods. Hospitalized subjects with decompensated cirrhosis and HRS-1 were enrolled. PTX or placebo was administered with AMO therapy for up to 14 days. The primary endpoint was HRS-1 resolution (serum creatinine ≤ 1.5 g/dL for > 24 h). Secondary endpoints were change in creatinine and MELD score, partial treatment response, 30-and 180-day overall and transplant free survival. Results. Twelve subjects with mean age 58.9 ± 6.2 years were enrolled and randomized. Mean MELD score was 26.5 ± 7.4 and 58.3% were male. Overall cohort 30- and 180-day survival was 58.3% and 33.3% respectively. Two subjects underwent liver transplantation. HRS-1 resolution (16.7% vs. 16.7%, p = 1.000), partial treatment response (33.3% vs. 16.7%, p = 0.505), change in creatinine (+0.48 g/dL, 95% CI -0.49-1.46 vs. +0.03 g/dL, 95% CI -0.640.70, p = 0.427), 30-day survival (66.6% vs. 50.0%, p = 0.558) and 180-day survival (50.0% vs. 16.7%, p = 0.221) were similar between the two groups. Serious adverse events necessitating treatment discontinuation were rare (n = 1, PTX). Discussion. The addition of PTX to AMO in the treatment of HRS-1 is safe when compared to the current standard of care. Future large-scale prospective study to validate the efficacy of this treatment seems warranted.