Durable response without recurrence to Tolvaptan improves long-term survival
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ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
Durable response without recurrence to Tolvaptan improves longterm survival Masato Nakai1 • Goki Suda1 • Akinori Kubo1 • Yoshimasa Tokuchi1 • Takashi Kitagataya1 • Ren Yamada1 • Taku Shigesawa1 • Kazuharu Suzuki1 • Akihisa Nakamura1 • Naoki Kawagishi1 • Masatsugu Ohara1 • Machiko Umemura1 Takuya Sho1 • Kenichi Morikawa1 • Koji Ogawa1 • Naoya Sakamoto1
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Received: 5 June 2020 / Accepted: 4 August 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background Decompensated liver cirrhosis patients with refractory ascites or pleural effusion have a poor prognosis. Tolvaptan has been used for treating water retention associated with cirrhosis. However, despite the short-term response, water retention recurrence is still observed in some cases. This study aimed to clarify the water retention recurrence rate and the relationship between long-term response without recurrence and prognosis. Methods Altogether, 100 patients with decompensated cirrhosis treated with tolvaptan were retrospectively analyzed. Recurrence was evaluated according to the criteria of the EASL clinical practice guideline. The recurrence rate and prognosis of non-responders, patients with recurrence, and long-term responders were analyzed. The baseline factors related to short-term response, recurrence, and long-term response were also evaluated. Results Approximately 31.0% of the short-term responders had recurrence. Although there was no significant difference in the prognosis by short-term response (p = 0.07), the long-term responders had a significantly better prognosis than those with recurrence and non-responders (p \ 0.01). Low CRP levels and high urinary Na/K ratios were significant factors related to short-term response, and the presence of acute kidney injury was also a factor related Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01721-8) contains supplementary material, which is available to authorized users. & Naoya Sakamoto [email protected] 1
Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo 060-8638, Japan
to non-response. The low CRP level (relapse: \ 1.10 mg/ dl, long-term response: \ 0.94 mg/dl) was identified as a factor related to recurrence and long-term response. Conclusion The long-term responders without recurrence had a significantly better prognosis. CRP was a useful predictor for long-term response, whereas renal function parameters were useful predictors for short-term response. Inflammation control may be important for long-term response and prognosis in cirrhosis patients with water retention. Keywords Tolvaptan Recurrence C-reactive protein Acute kidney injury Prognosis Abbreviations BUN Blood urea nitrogen CRP C-reactive protein AKI Acute kidney injury TVP Tolvaptan AVP Arginine vasopressin HCV Hepatitis C virus HBV Hepatitis B virus EASL European Association for the Study of Liver P–V shunt Peritoneo-ve
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