The impact of continuous terlipressin infusion on complications of end-stage liver disease

End-stage liver disease, known as cirrhosis, is a common condition in Western society, and is associated with poor prognosis. Cirrhosis can lead to many complications, including fluid retention, kidney impairment and increased risk of infection. Many patients with cirrhosis are malnourished and also develop muscle wasting. Terlipressin is a medication used in the management of severe bleeding and some forms of kidney impairment associated with liver disease, but little is known about its impact on other complications of liver disease such as muscle wasting, fluid retention or infection. Early data from our centre suggests that terlipressin can also improve nutrition in this population. This study will attempt to confirm that long-term terlipressin can improve nutrition and muscle mass in patients with end-stage liver disease as well as understanding the mechanisms by which this occurs. It will also look at whether it improves other complications such as ascites (fluid retention in the abdominal cavity), infection, hospital admissions and healthcare costs. Participants will undertake 2 study periods: an observation period and a treatment period, where they will receive a continuous infusion of terlipressin for 12 weeks which will be administered via the Hospital-in-the-Home program. They will undergo assessment of muscle strength and function using radiology scans and bedside tests, as well as monthly blood tests during both study periods. Hospital records will be accessed to identify causes of hospital admission and estimates of infection rates and to calculate direct healthcare costs. Quality of life will be assessed using validated questionnaires. In total, the participants will be involved in the study for a period of 6 months.