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An update on the pathogenesis and clinical management of cirrhosis with refractory ascites
Shuet Fong Neong, Danielle Adebayo & Florence Wong
Received 02 Aug 2018, Accepted 30 Nov 2018, Accepted author version posted online: 03 Dec 2018
Download citation https://doi.org/10.1080/17474124.2018.1555469
Accepted author version
Abstract
Introduction: Ascites commonly complicates cirrhosis, becoming refractory to treatment with diuretics and sodium restriction in approximately 10% of patients. Pathogenesis of refractory ascites (RA) is multifactorial, the common final pathway being renal hypoperfusion and avid sodium retention. Refractory ascites has a negative prognostic implication in the natural history of cirrhosis. Management of RA include sodium restriction and regular large volume paracentesis (LVP) with albumin infusions, preventing paracentesis-induced circulatory dysfunction. In appropriate setting, transjugular intrahepatic porto-systemic shunt (TIPS) can be considered. Ascites clearance with TIPS can lead to nutritional improvement, avoiding sarcopenia. Liver transplantation (LT) remains the definitive treatment for eligible candidates.
Areas covered: Our review summarizes current updates on pathogenesis and clinical management of RA including potential future therapeutic options such as the automated slow-flow ascites pump, chronic outpatient albumin infusion and cell-free and concentrated ascites reinfusion therapy.
Expert commentary: Standard of care in patients with RA include LVP with albumin replacement and prompt referral for LT where indicated. Other novel therapeutic options on the horizon include automated low-flow ascites pump and cell-free, concentrated albumin reinfusion therapy.
Keywords: cirrhosis, Inflammation, Liver transplantation, Refractory ascites, TIPS, sodium retention |
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发表于 2018-12-6 09:03