Combination Treatment With Octreotide, Midodrine, and Albumin Improves Survival in Patients With Type 1 and Type 2 Hepatorenal Syndrome

Introduction: Few therapeutic modalities exist for the treatment of hepatorenal syndrome (HRS). The combination of octreotide. midodrine, and albumin has shown possible benefit in small preliminary studies in improving renal function and short-term survival. Methods: We examined the effect of octreotide, midodrine, and albumin off survival (censored for liver transplantation) and renal function in patients with HRS type I and type 2, compared with a historical cohort that did not receive this therapy (control group). Results: Seventy-five patients with HRS received octreotide, midodrine. and albumin and 87 did not constitute the control group. HRS type I was present in 102 individuals and HRS type 2 in 60. Transplantation was performed in 45%, of patients in the treatment group as compared with 26% of patients in the control group although a significant difference in transplantation rate was seen in only HRS type 2. In the treatment arm. transplant-free survival was higher compared with the control arm (median survival 101 d vs. 18d, P < 0.0001). Survival was significantly better in the treatment arm in both HRS type 1 (P = 0.0003) and HRS type 2 (P = 0.009). In multivariable analysis, treatment with octreotide, midodrine, and albumin (P = 0.0001) and HRS type 2 (P = 0.05) were independently associated with improved Survival. Renal function was significantly improved at I month (glomerular filtration rate 48 mL/min) in the treatment group compared with the control group (34 mL/min). P = 0.03. Conclusions: The therapeutic regimen of octreotide. midodrine. and albumin significantly improved short-term survival and renal function in both HRS type 1 and type 2. This may provide a significant benefit as a bridge to liver transplantation in HRS type 1 and may prevent progression of HRS type 2 to HRS type 1.