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Durable response without recurrence to Tolvaptan improves long-term survival.

Masato Nakai1, Goki Suda1, Akinori Kubo1

  • 1Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan.

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PubMed
Summary

Tolvaptan helps cirrhosis patients with water retention, but recurrence is common. Long-term responders without recurrence showed significantly better prognosis, highlighting inflammation control

Keywords:
Acute kidney injuryC-reactive proteinPrognosisRecurrenceTolvaptan

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Area of Science:

  • Hepatology
  • Internal Medicine
  • Pharmacology

Background:

  • Decompensated cirrhosis with refractory ascites/pleural effusion carries a poor prognosis.
  • Tolvaptan is used for fluid retention in cirrhosis, but recurrence is observed.
  • This study investigates recurrence rates and long-term outcomes with tolvaptan.

Purpose of the Study:

  • To clarify the recurrence rate of water retention in cirrhosis patients treated with tolvaptan.
  • To analyze the relationship between long-term response without recurrence and patient prognosis.
  • To identify factors associated with short-term response, recurrence, and long-term response.

Main Methods:

  • Retrospective analysis of 100 decompensated cirrhosis patients treated with tolvaptan.
  • Evaluation of recurrence based on EASL clinical practice guidelines.
  • Analysis of recurrence rates and prognosis for non-responders, recurrent cases, and long-term responders.

Main Results:

  • 31.0% of short-term responders experienced recurrence.
  • Long-term responders demonstrated a significantly better prognosis than recurrent or non-responders (p < 0.01).
  • Low CRP levels and high urinary Na/K ratios predicted short-term response; low CRP (<0.94 mg/dl) predicted long-term response.

Conclusions:

  • Long-term tolvaptan responders without recurrence have a significantly better prognosis.
  • CRP levels are predictive of long-term response, while renal function predicts short-term response.
  • Controlling inflammation is crucial for long-term response and prognosis in cirrhosis patients with fluid retention.