Tailor refractory ascites treatment according to patient context, study says

Refractory ascites (RA) is a severe complication of liver cirrhosis leading to poor prognosis and is curable only through liver transplantation, reports a recent meta-analysis.

While different interventions, including the use of transjugular intrahepatic portosystemic shunts (TIPS) or an Alfapump, yield favourable outcomes, the current findings emphasize the importance of tailoring treatment according to the individual patient’s characteristics and disease status.

Drawing from PubMed and Embase, the researchers retrieved 77 eligible studies. Aside from TIPS and the Alfapump, other interventions assessed included peritoneovenous shunt (PVS), large volume paracentesis (LVP), and permanent indwelling peritoneal catheter (PIPC).

Overall, TIPS yielded a cumulative 1-year mortality rate of 33 percent (95 percent confidence interval [CI], 29–39), with significant heterogeneity of evidence (p<0.001). Such heterogeneity was partly due to the lower 1-year mortality in newer studies (26 percent vs 44 percent), which in turn the researchers attributed to better patient selection.

Alfapump, in comparison, led to a 6-month mortality rate of 24 percent and was associated with acute kidney injury in 31 percent. Heterogeneity of evidence for both outcomes was nonsignificant.

Patients treated with PVS and LVP showed 1-year mortality rates of 44 percent and 45 percent, respectively. In PIPC, overall mortality was 66 percent. All mortality outcomes for these three intervention modalities showed significant heterogeneity of evidence.

“Our results highlight the importance of treatment allocation depending on the patient’s individual characteristics and the overall situation, but also that RA still has a poor prognosis and the only curative option is liver transplantation,” the researchers said.