Survival Benefit of Tolvaptan for Refractory Ascites in Patients with Advanced Cirrhosis

2018 ◽  
Vol 36 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Kazuto Tajiri ◽  
Yoshiharu Tokimitsu ◽  
Hiroyuki Ito ◽  
Yoshinari Atarashi ◽  
Kengo Kawai ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Renal Function ◽  
Body Weight ◽  
Multivariate Analysis ◽  
Liver Cirrhosis ◽  
Survival Benefit ◽  
Refractory Ascites ◽  
Body Weight Change ◽  
Decompensated Liver Cirrhosis ◽  
Advanced Cirrhosis

Aims: The study aimed to evaluate the effects of tolvaptan treatment on survival of patients with decompensated liver cirrhosis with refractory ascites. Methods: This multicenter, retrospective, observational study included patients with cirrhosis who were treated with tolvaptan for hepatic ascites refractory to conventional diuretics. Patients who could and could not decrease accompanying diuretics within 1 month after tolvaptan administration were defined as the “Decreased” and “Not-decreased” groups, respectively. Results: Median body weight change 1 week after tolvaptan treatment was –1.95 kg, with the 50% of patients experiencing a 2 kg/week reduction. Spot urinary sodium was found to be a better predictor of tolvaptan response than liver function and liver fibrosis markers. Median survival was significantly longer (not reached versus 116 days, p = 0.005) and serum creatinine concentrations 12 weeks after tolvaptan administration significantly lower (0.99 vs. 1.55 mg/dL, p < 0.05) in the Decreased than in the Not-decreased group. Multivariate analysis showed that the presence of viable hepatocellular carcinoma (hazards ratio [HR] 2.14, p = 0.02) and a decrease in diuretics were independently prognostic of survival (HR 0.36, p < 0.01). Conclusions: The maintenance of renal function is essential in enhancing survival of patients with cirrhosis. Doses of diuretics should be adjusted appropriately during tolvaptan treatment.

Is there a survival benefit in interventional radiology for hepatocellular carcinoma in patients with Child-Pugh C liver cirrhosis?: A multicenter study

2015 ◽  
Vol 46 (6) ◽  
pp. 521-528 ◽  
Author(s):  
Atsushi Hiraoka ◽  
Takashi Kumada ◽  
Kojiro Michitaka ◽  
Hidenori Toyoda ◽  
Toshifumi Tada ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Interventional Radiology ◽  
Liver Cirrhosis ◽  
Multicenter Study ◽  
Survival Benefit

scholarly journals Survival Benefit of Locoregional Treatment for Hepatocellular Carcinoma with Advanced Liver Cirrhosis

Liver Cancer ◽  
2016 ◽  
Vol 5 (3) ◽  
pp. 175-189 ◽  
Author(s):  
Satoshi Kitai ◽  
Masatoshi Kudo ◽  
Naoshi Nishida ◽  
Namiki Izumi ◽  
Michiie Sakamoto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Survival Benefit ◽  
Locoregional Treatment ◽  
Advanced Liver Cirrhosis

Inappropriately low angiotensin II generation: A factor determining impaired renal function and reduced survival in patients with decompensated liver cirrhosis

2003 ◽  
Vol 124 (4) ◽  
pp. A697
Author(s):  
Giovanni Sansoe' ◽  
Stefano Silvano ◽  
Giulio Mengozzi ◽  
Luca Todros ◽  
Antonina Smedile ◽  
...  
Keyword(s):  
Renal Function ◽  
Liver Cirrhosis ◽  
Angiotensin Ii ◽  
Impaired Renal Function ◽  
Decompensated Liver Cirrhosis

Clinical Factors Predicting the Effect of Tolvaptan for Refractory Ascites in Patients with Decompensated Liver Cirrhosis

2016 ◽  
Vol 34 (6) ◽  
pp. 659-664 ◽  
Author(s):  
Hirokazu Chishina ◽  
Satoru Hagiwara ◽  
Naoshi Nishida ◽  
Kazuomi Ueshima ◽  
Toshiharu Sakurai ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Treatment Effect ◽  
Oral Treatment ◽  
Univariate Analysis ◽  
Urine Volume ◽  
The Body ◽  
Refractory Ascites ◽  
Delayed Effect ◽  
Decompensated Liver Cirrhosis ◽  
Early Effect

Objective: Refractory ascites reduces the quality of life of liver cirrhosis patients. Albumin preparation and diuretics, such as furosemide, have been used to treat refractory ascites, but the effect was poor in many patients. In this study, we analyzed patients treated with tolvaptan (TLV) at our hospital and investigated predictors of the effect. Methods: The subjects were 70 patients for whom TLV was introduced to treat refractory ascites who could be analyzed between November 2013 and March 2015 at our hospital. Patient background before initiation of oral TLV treatment, the dose of diuretics, and each item of biochemical tests of blood and urine were investigated, and factors correlated with the treatment effect were analyzed. An increase of ≥1,000 ml in the daily urine volume from the day before oral treatment or a decrease of ≥1 kg in the body weight within 7 days as an early effect was observed in 33 patients and not observed in 37 patients. TLV treatment was continued for 60 days or longer in 12 of the 37 patients in whom no early effect was observed, and the presence or absence of a delayed effect and predictors of the effect were investigated. A decrease in ascites on abdominal CT with improvement of subjective symptoms at 60 days was defined as a delayed effect. Results: When early predictors of the effect were investigated by univariate analysis, serum blood urea nitrogen (BUN) and serum creatinine (Cr) were significantly higher in the non-responder group (BUN: p = 0.03, Cr: p = 0.04), but no factor independently associated with the treatment effect was extracted on multivariate analysis. The delayed effect was noted in 4 (33.3%) of the 12 patients, but no predictor of the effect before treatment was identified. However, reactions, such as an increase in serum Na and reduction of urinary osmotic pressure, were observed early after TLV administration in some patients in whom the delayed effect was observed. Conclusions: The diuretic effect of TLV may decrease in renal hypofunction patients. Since the delayed effect was noted in a specific ratio of patients, continuation of TLV administration is an option even though the early treatment effect is poor unless ascites aggravates or adverse effects develop.

Heparin Elimination in Patients with Liver Cirrhosis

1977 ◽  
Vol 38 (03) ◽  
pp. 0701-0706 ◽  
Author(s):  
Arne N. Teien
Keyword(s):  
Renal Function ◽  
Body Weight ◽  
Liver Cirrhosis ◽  
Normal Renal Function ◽  
Half Life ◽  
Antithrombin Iii ◽  
Normal Liver ◽  
Normal Group ◽  
Heparin Concentration ◽  
The Difference

SummaryHeparin (100 U/kg body-weight) was injected intravenously, and heparin concentration in plasma determined by polybrene titration. Mean heparin half-life was 117.8 min in a group of patients with liver cirrhosis and normal renal function (n = 6) as compared to 74.0 min in the normal group (n = 6). The difference between the two groups is statistically significant (p ≈ 0. 02). Heparin half-life was correlated to galactose half-life in the patients (r = 0.83, p = 0. 05). The findings suggest that heparin is metabolized in the liver. There was a significant fall in antithrombin III activities in the normals, but not in the patients. A possible explanation may be that the normal liver removes heparin bound to antithrombin III, and that this function is impaired in liver cirrhosis.

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