Palliative Long-term Abdominal Drains Large Volume Paracenteses for the Management of Refractory Ascites in End-stage Liver Disease

Overview

Journal World J Hepatol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2024 Apr 5

PMID 38577536

Authors

Senamjit Kaur

Rodrigo V Motta

Bryony Chapman

Victoria Wharton

Jane D Collier

Francesca Saffioti

Affiliations

Soon will be listed here.

Abstract

Background: Long-term abdominal drains (LTAD) are a cost-effective palliative measure to manage malignant ascites in the community, but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice. The safety and cost-effectiveness of LTAD are currently being studied in this setting, with preliminary positive results. We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis (LVP) in patients with cirrhosis and refractory ascites and may offer advantages in patients' quality of life.

Aim: To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.

Methods: A retrospective, observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted. Fisher's exact tests and the Mann-Whitney test were used to compare qualitative and quantitative variables, respectively. Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.

Results: Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP. The baseline characteristics were similar between the groups. Prophylactic antibiotics were more frequently prescribed in patients with LTAD ( = 0.012), while the incidence of peritonitis did not differ between the two groups ( = 0.46). The incidence of acute kidney injury ( = 0.014) and ascites/drain-related hospital admissions ( = 0.004) were significantly higher in the LVP group. The overall survival was similar in the two groups (log-rank = 0.26), but the endpoint-free survival was significantly shorter in the LVP group ( = 0.003, < 0.001, = 0.018 for first ascites/drain-related admission, acute kidney injury and drain-related complications, respectively).

Conclusion: The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective, safe, and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

Citing Articles

Drainage of ascites in cirrhosis.

Yang J, Peng Y, Zeng H, Lin X, Xu Z World J Hepatol. 2024; 16(9):1245-1257.

PMID: 39351514 PMC: 11438587. DOI: 10.4254/wjh.v16.i9.1245.

References

Weil-Verhoeven D, Di Martino V, Stirnimann G, Cervoni J, Nguyen-Khac E, Thevenot T . Alfapump implantable device in management of refractory ascites: An update. World J Hepatol. 2022; 14(7):1344-1356. PMC: 9376776. DOI: 10.4254/wjh.v14.i7.1344. View

Mansour D, Masson S, Corless L, Douds A, Shawcross D, Johnson J . British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 2: decompensated cirrhosis. Frontline Gastroenterol. 2023; 14(6):462-473. PMC: 10579554. DOI: 10.1136/flgastro-2023-102431. View

Macken L, Mason L, Evans C, Gage H, Jordan J, Austin M . Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial. Trials. 2018; 19(1):401. PMC: 6062920. DOI: 10.1186/s13063-018-2779-0. View

Hudson B, Round J, Georgeson B, Pring A, Forbes K, McCune C . Cirrhosis with ascites in the last year of life: a nationwide analysis of factors shaping costs, health-care use, and place of death in England. Lancet Gastroenterol Hepatol. 2017; 3(2):95-103. DOI: 10.1016/S2468-1253(17)30362-X. View

Fleming K, Aithal G, Card T, West J . The rate of decompensation and clinical progression of disease in people with cirrhosis: a cohort study. Aliment Pharmacol Ther. 2010; 32(11-12):1343-50. DOI: 10.1111/j.1365-2036.2010.04473.x. View

Cooper M, Pollard A, Pandey A, Bremner S, Macken L, Evans C . Palliative Long-Term Abdominal Drains Versus Large Volume Paracentesis in Refractory Ascites Due to Cirrhosis (REDUCe Study): Qualitative Outcomes. J Pain Symptom Manage. 2020; 62(2):312-325.e2. DOI: 10.1016/j.jpainsymman.2020.12.007. View

Aagaard N, Malago M, De Gottardi A, Thomas M, Sauter G, Engelmann C . Consensus care recommendations for alfapump in cirrhotic patients with refractory or recurrent ascites. BMC Gastroenterol. 2022; 22(1):111. PMC: 8905806. DOI: 10.1186/s12876-022-02173-5. View

Ufere N, Robinson B, Donlan J, Indriolo T, Bloom J, Scherrer A . Pilot Randomized Controlled Trial of an Advance Care Planning Video Decision Tool for Patients With Advanced Liver Disease. Clin Gastroenterol Hepatol. 2021; 20(10):2287-2295.e3. DOI: 10.1016/j.cgh.2021.10.027. View

Salerno F, Borroni G, Moser P, Badalamenti S, Cassara L, Maggi A . Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993; 88(4):514-9. View

10.

Karlsen T, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E . The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet. 2021; 399(10319):61-116. DOI: 10.1016/S0140-6736(21)01701-3. View

11.

Arroyo V, Gines P, Gerbes A, DUDLEY F, Gentilini P, Laffi G . Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996; 23(1):164-76. DOI: 10.1002/hep.510230122. View

12.

Bureau C, Adebayo D, Chalret de Rieu M, Elkrief L, Valla D, Peck-Radosavljevic M . Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study. J Hepatol. 2017; 67(5):940-949. DOI: 10.1016/j.jhep.2017.06.010. View

13.

Fleming N, Alvarez-Secord A, von Gruenigen V, Miller M, Abernethy A . Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review. J Pain Symptom Manage. 2009; 38(3):341-9. DOI: 10.1016/j.jpainsymman.2008.09.008. View

14.

. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018; 69(2):406-460. DOI: 10.1016/j.jhep.2018.03.024. View

15.

Shinall Jr M, Karlekar M, Martin S, Gatto C, Misra S, Chung C . COMPASS: A Pilot Trial of an Early Palliative Care Intervention for Patients With End-Stage Liver Disease. J Pain Symptom Manage. 2019; 58(4):614-622.e3. PMC: 6754773. DOI: 10.1016/j.jpainsymman.2019.06.023. View

16.

Baumann A, Wheeler D, James M, Turner R, Siegel A, Navarro V . Benefit of Early Palliative Care Intervention in End-Stage Liver Disease Patients Awaiting Liver Transplantation. J Pain Symptom Manage. 2015; 50(6):882-6.e2. DOI: 10.1016/j.jpainsymman.2015.07.014. View

17.

White J, Carolan-Rees G . PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites: a NICE Medical Technology Guidance. Appl Health Econ Health Policy. 2012; 10(5):299-308. DOI: 10.1007/BF03261864. View

18.

Khwaja A . KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4):c179-84. DOI: 10.1159/000339789. View

19.

Gines P, Tito L, Arroyo V, Planas R, Panes J, Viver J . Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988; 94(6):1493-502. DOI: 10.1016/0016-5085(88)90691-9. View

20.

Macken L, Corrigan M, Prentice W, Finlay F, McDonagh J, Rajoriya N . Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document. Frontline Gastroenterol. 2022; 13(e1):e116-e125. PMC: 9234735. DOI: 10.1136/flgastro-2022-102128. View