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Hepatology. 2015 Aug;62(2):567-74. doi: 10.1002/hep.27709. Epub 2015 Feb 13.

Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial.

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Department of Medicine, DIMED, Padua, Italy.
Division of Gastroenterology and Hepatology, Mayo Clinic, College of Medicine, Rochester, MN.
Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
Internal Medicine, University of Udine, Udine, Italy.
IRCCS Hospital, University of Milan, Milan, Italy.
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Internal Medicine, University of Florence, Florence, Italy.
General Hospital of Omegna (Verbania), Verbania, Italy.
Hospital Giovanni XXIII of Monastier di Treviso, Treviso, Italy.
General Hospital of Comiso (Ragusa), Ragusa, Italy.
Unit of Hepatic Emergencies and Liver Transplantation, University of Padua, Padua, Italy.


Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4%) compared to the MID/OCT group (6/21, 28.6%), P = 0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival.


Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS.

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