Terlipressin use in malignancy-associated hepatorenal syndrome

Hepatorenal syndrome acute kidney injury (HRS–AKI) is a highly fatal complication of decompensated cirrhosis. While liver transplant is the only curative option for HRS, there are supportive care therapies with demonstrated benefit that are commonly utilized, including terlipressin, a V1a receptor agonist that received FDA approval for the treatment of HRS–AKI in 2022. Despite increasing utilization of terlipressin in the treatment of HRS–AKI in recent years, it does not appear that it has previously been used in the context of a patient with concurrent HRS–AKI and active malignancy. We report a case of a 58-year-old patient with a history of cirrhosis in the setting of pancreatic adenocarcinoma with liver metastasis who was successfully treated for HRS–AKI with terlipressin on three separate occasions. To our knowledge, this is the first report of terlipressin use in a patient with malignant hepatorenal syndrome. While little is known about the use of this agent in onco-nephrology patients, this case highlights the potential for terlipressin use in HRS–AKI in cirrhotic patients with underlying malignancy.