Real-World Experience of Home Continuous Terlipressin Infusion for Complications of Portal Hypertension

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INTRODUCTION: Home continuous terlipressin infusion (CTI) is an emerging therapy for the treatment of portal hypertensive complications in decompensated cirrhosis. This study presents efficacy and safety data of long-term CTI in a longitudinal cohort. METHODS: All patients treated with at least 2 weeks of home CTI for portal hypertensive complications between 2013 and 2023 were included. Recorded data include handgrip strength (HGS), weight, serum biochemistry, and paracentesis frequency pre-CTI and during CTI. Adverse events related to CTI and unplanned readmissions before and during CTI were recorded. Patients were followed until liver transplantation, CTI cessation, death, or census date. RESULTS: One hundred and two transplant-eligible patients with median Model for End-Stage Liver Disease with sodium 24 (interquartile range 20-29) were treated with CTI for 84 (58-151) days. Compared with pre-CTI, HGS increased by 2.84 kg (95% confidence interval [CI] 1.89-3.80), while body weight reduced by 10.6 kg (95% CI -12.70 to -8.52) (both P < 0.0001). Paracentesis frequency reduced by 58% ( P = 0.006) and median creatinine by 0.61 mg/dL (95% CI -0.87 to -0.3) ( P < 0.001). Serum sodium did not significantly change. Over a cumulative total of 12,312 days, 49 treatment-related adverse events were recorded in 36 patients, 84% of which were central line related. There were no vascular events, episodes of pulmonary edema, or events requiring treatment cessation. DISCUSSION: This study demonstrates the safety of home CTI in a real-world cohort of over 100 well-selected transplant-eligible patients with decompensated cirrhosis. It confirms previous findings that long-term CTI is associated with increased HGS and reduced paracentesis, in addition to its established benefit on renal function. These data provide strong clinical rationale for further prospective randomized trials to investigate the use of CTI as a bridge to liver transplant.

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