Treatment of refractory ascites

Abstract

In Japan, the primary therapeutic options for refractory ascites include pharmacotherapy with diuretics, paracentesis with albumin infusion, peritoneovenous shunt using Denver shunt, cell-free and concentrated ascites reinfusion therapy (CART), transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. Recently, the novel diuretic tolvaptan (vasopressin V2 receptor antagonist) has been shown to be effective in the treatment of refractory ascites or hyponatremia in patients with liver cirrhosis. However, a positive effect on the prognosis has not been reported. Patients with diuretic-resistant ascites are often treated by paracentesis with albumin infusion or CART. Although TIPS is effective in controlling refractory ascites, it frequently causes hepatic encephalopathy and requires technical skills to perform. Liver transplantation is the only definitive therapy for refractory ascites; however, it cannot always be performed due to the shortage of donors in Japan.