Management of refractory cirrhotic ascites: challenges and solutions

Hepatic Medicine : Evidence and Research
Hiroshi FukuiHitoshi Yoshiji

Abstract

Among the various risky complications of liver cirrhosis, refractory ascites is associated with poor survival of cirrhotics and persistently worsens their quality of life (QOL). Major clinical guidelines worldwide define refractory ascites as ascites that cannot be managed by medical therapy either because of a lack of response to maximum doses of diuretics or because patients develop complications related to diuretic therapy that preclude the use of an effective dose of diuretics. Due to the difficulty in receiving a liver transplantation (LT), the ultimate solution for refractory ascites, most cirrhotic patients have selected the palliative therapy such as repeated serial paracentesis, transjugular intrahepatic portosystemic shunt, or peritoneovenous shunt to improve their QOL. During the past several decades, new interventions and methodologies, such as indwelling peritoneal catheter, peritoneal-urinary drainage, and cell-free and concentrated ascites reinfusion therapy, have been introduced. In addition, new medical treatments with vasoconstrictors or vasopressin V2 receptor antagonists have been proposed. Both the benefits and risks of these old and new modalities have been extensively studied in relation to the pathophysi...Continue Reading

Citations

Sep 11, 2019·Liver International : Official Journal of the International Association for the Study of the Liver·Lucas H P BerntsEric T T L Tjwa
Oct 23, 2019·PeerJ·Beata Kasztelan-Szczerbinska, Halina Cichoz-Lach
Mar 30, 2021·World Journal of Gastroenterology : WJG·Ramesh KumarUtpal Anand

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