Austin Health pioneers world-first treatment for patients with liver failure

Devon Warren used to have 10 litres of fluid drained from his abdomen through a needle as a result of his chronic liver disease.

But now Mr Warren is just one of 14 transplant recipients in Victoria who've benefited from a new treatment pioneered by Austin Health that could change the way people with liver disease are cared for.

In a world-first, Austin Health has reapplied how the drug Terlipressin is given to patients waiting for a liver transplant, reducing the length of hospital stays and improving their post-surgery recovery.

Austin Health Head of Intestinal Rehabilitation and Transplantation, Dr Adam Testro oversaw Mr Warren's treatment along with 21 other liver patients, 14 of whom have successfully received transplants since 2014.

Many patients like Mr Warren develop Hepatorenal syndrome, a pre-terminal condition with a life expectancy of 30 to 40 days, in which the kidneys fail before the patient succumbs to liver disease.

"We have a problem with a suspected survival of one month and waiting time for a transplant of nine months, so we desperately needed some intervention to enable these patients to access liver transplantation," Dr Testro said.

Terlipressin constricts blood vessels around the bowel, increasing the blood supply to the kidneys and improving how they function.

Typically liver patients with kidney issues have to be admitted to hospital to receive injections of the drug.
But Austin Health's Victorian Liver Transplant Unit has developed a continuous drip or infusion method of delivering Terlipressin over 24 hours, meaning patients can receive treatment at home, rather than being admitted to hospital for months at a time.

"We manage to save about $1,000 per patient, per day when they're on the infusion," Dr Testro said.
"We have quite a number of rural patients who end up having to come to Melbourne so to return them back to their communities and their family is an enormous benefit to them.

"They're having life-saving therapy but in their own homes."

Dr Testro said a flow-on benefit of the Terlipressin treatment was that it reduced demand for kidney transplants.

"There's a significant risk in patients with advanced kidney failure and who have liver failure of needing to have a combined liver and kidney transplant," he said.

"By using a medication that can either improve or in most cases normalise kidney function before a liver transplant, we would hope the need to have combined kidney-liver transplants would significantly decrease."

Dr Testro said the treatment had the potential to become a new standard of care for liver patients, with little to no negative side effects.

"We have had a number of enquiries from interstate and from New Zealand to share our protocols with them but to my knowledge we're still the only centre in the world doing this," he said.

Chrissie Warren says the Terlipressin treatment offered her husband a better quality of life.

"We went from weekly visits [to the hospital] to sometimes up to six weeks," she said.

"The volume of fluid drained decreased from what it was weekly, because before the Terlipressin it was an average of eight to 10 litres per week and then it went down to between five and six."

Devon recently received a liver transplant at Austin Health.

At his worst Mr Warren said he was "a skeleton wrapped in skin" and weighed less than 60 kilograms.
"When I was lying in the bed in ICU, I could feel this funny tingling sensation coming into my bones, my cheeks, through my whole body ... and when Chrissie saw me she said 'You just look so different already'," he said.

"It was the drugs I was on and the liver working, and my body adjusting to a new life."