Controversies in terlipressin and transplantation in the United States: How do we MELD the two?

Controversies in terlipressin and transplantation in the United States: How do we MELD the two?
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美国关于特利加压素和移植的争议：我们如何融合两者？

DOI：
10.1097/lvt.0000000000000370
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发表时间：
2024
期刊：
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
影响因子：
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通讯作者：
fromtheHRS-HarmonyConsortium
fromtheHRS-HarmonyConsortium
中科院分区：
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文献类型：
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作者：
Przybyszewski,EricM;Wilechansky,RobertM;McLeanDiaz,Paige;Allegretti,AndrewS;VanWagner,LisaB;Cullaro,Giuseppe;Levitsky,Josh;Ginès,Pere;Piano,Salvatore;Asrani,SumeetK;Patidar,KavishR;fromtheHRS-HarmonyConsortium

文献摘要

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肝肾综合征-急性肾损伤（HRS-AKI）是肝硬化的严重并发症，预后不良。最近食品和药物管理局批准特利加压素对管理美国的HRS-AKI和肝脏分配具有重大意义。特利加压素在欧洲已经上市十多年，一些国家已经适应了政策变化，如终末期肝病模型（MELD）评分“锁定”HRS-AKI。在这篇文章中，我们概述了特利加压素使用的欧洲经验，并探讨了特利加压素治疗HRS-AKI是否有资格在美国对治疗有反应的患者中获得MELD评分“锁定”的问题。MELD锁定的参数包括保护特利加压素应答者或部分应答者的等待列表优先级，这些应答者可能由于特利加压素治疗窗口中的MELD降低而错过提供。反对MELD锁定的论点包括特利加压素可能产生持久的反应并改善总体生存率，并且由于成本和可用性，无法保证公平获得特利加压素。随后，我们讨论了在美国研究特利加压素实施的下一步建议。一个成功的方法将需要所有主要利益相关者的参与，并动员我们的移植界带头在这一领域的研究。
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.