The Use of Terlipressin for Decompensated Cirrhosis in a Regional Hospital in the Home Setting – Case Series

Background Terlipressin is an established therapy for hepatorenal syndrome and variceal bleeding in the setting of decompensated cirrhosis. The administration of terlipressin for these indications or as a bridge to transplantation often requires prolonged infusions and therefore may be appropriate to administer in an ambulatory hospital in the home (HITH) setting. The literature surrounding its use at home is limited and often restricted to tertiary academic metropolitan areas. We describe the first case series of patients receiving terlipressin for treatment of portal hypertensive complications in a regional hospital. Methods We performed a retrospective case series of all patients treated with terlipressin via continuous infusion in our HITH in a regional hospital in Australia from 2020 to 2025. Patients were identified using the electronic medical record (EMR) and pharmacy dispensing records. Patient demographics, rationale for terlipressin receipt, unplanned escalations of care, and reason for terlipressin discontinuation were all collected. Results We identified 9 patients who received terlipressin for decompensated cirrhosis. The mean age was 51, 55% were female. The most common indication for terlipressin was refractory fluid overload. The mean duration of terlipressin receipt via HITH was 129 days (range 21 to 380). Each patient had an unexpected escalation of care a mean of 3 times (range 1 to 5) with variceal bleeding, peripherally inserted central venous catheter complications and infection being the most common (4, 5 and 6 episodes respectively). Terlipressin was well tolerated with only 3 patients needing cessation (hyponatraemia, hypotension and over diuresis triggering encephalopathy). 3 patients received liver transplants as the end point of their therapy. Conclusion Terlipressin can feasibly be used in a regional HITH setting but is associated with an appreciable return to bed-based care rate due to natural history rate of complications of decompensated cirrhosis, necessitating a close working relationship with local and tertiary hepatology services.