Home-based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Background Onset of refractory ascites (RA) is the hallmark of end-stage liver disease. If liver transplantation (LTx) is not available and contraindications for a transjugular portosystemic shunt (TIPS) are present, repeated paracentesis remains the standard of care (SOC). Home-based, tunnelled peritoneal catheters (PeCa) have been suggested as an alternative treatment option. However, data on patients with liver cirrhosis are scarce. This study aimed to evaluate the safety of PeCa in these patients compared to SOC. Methods Overall, 223 patients with liver cirrhosis, a contraindication for TIPS and RA were included in this retrospective study. PeCa implant was performed in 152 patients, whereas 71 patients were treated with SOC. Analysed end points included device explant-free survival, mortality, AKI and hyponatraemia. In the second approach, propensity score matching (PPSM) was performed to adjust for confounding factors. Results In patients with PeCa, median device explant-free survival was 74 days and 52 explants were recorded within the first 90 days. Within 90 days, patients with PeCa had a numerically lower mortality compared to SOC (p = 0.11) and SBP incidence did not differ (p = 0.82). Regarding AKI and hyponatraemia, there was a trend towards a higher incidence in the PeCa group (p = 0.13 and p = 0.08), and the risk for rehospitalisation was higher in those with a PeCa (HR: 2.11, p = 0.04). After PPSM, mortality was lower in the PeCa group (HR:0.40; p = 0.03), whereas the incidence of SBP and hyponatraemia was comparable (p = 0.80 and p = 0.28) and AKI was more frequent in those with a PeCa (p = 0.08). Conclusion The implant of PeCa allows home-based therapy of RA in patients with liver cirrhosis and contraindication for TIPS. However, the risk for complications such as AKI or hyponatraemia has to be considered and prospective studies are needed.

Automated summary

The implantation of PeCa for home-based therapy of refractory ascites in patients with liver cirrhosis and contraindications for TIPS is feasible, but the risk of complications such as AKI or hyponatremia must be considered, and prospective studies are needed to confirm.