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. 2024 Apr 2;23(3):316-324.
doi: 10.1007/s11901-024-00669-0.

Outcomes in Cirrhosis-Related Refractory Ascites with Emphasis on Palliative Care: Single-Centre Experience and Literature Review

Marcus Rex English  1 , Jordache Ellis  2 , Sumita Verma  1   2 , Yazan Haddadin  1   2
Affiliations

Outcomes in Cirrhosis-Related Refractory Ascites with Emphasis on Palliative Care: Single-Centre Experience and Literature Review

Marcus Rex English et al. Curr Hepatol Rep. .

Abstract

Purpose of review: Despite refractory ascites (RA) due to cirrhosis having a median transplant-free survival of 6-12 months, palliative care (PC) input remains uncertain. We aimed to review the existing literature on clinical outcomes in cirrhosis-related RA and report the findings of a single-centre retrospective cohort study with a special focus on linkage to PC in this cohort of patients.

Recent findings: Our study and subsequent literature review confirm the high mortality associated with cirrhosis-related RA (19-55% 1-year mortality) with only a minority of patients receiving curative options (3-23%). Despite this, in our study only a minority of patients (33%) were referred to PC. None of the studies identified in the scoping review makes any references to palliative care use.

Summary: Our own data and a literature review confirm that, despite high mortality, only a minority with RA due to cirrhosis are referred for specialist PC input and often too late in their disease trajectory. Future research should focus on patient-centred outcomes in this cohort of patients where optimising quality-of-life and facilitating advanced care planning should be a priority.

Keywords: Advanced chronic liver disease; Large-volume paracentesis; Liver transplantation; Long-term abdominal drains; Quality of life; Recurrent ascites.

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Conflict of interest statement

Conflict of Interest Jordache Ellis and Marcus English report no conflicts of interest. Yazan Haddadin is funded by the National Institute for Health and care Research (NIHR) (HTA 133899). Grant recipient is Sumita Verma. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Sumita Verma has received research grants, speaker and consultancy fees from Gilead Sciences and speaker fees from Dr Falk. Rocket Medial and Becton Dickinson have provided/providing LTADs free of cost for the REDUCe and REDUCe 2 studies, for which Sumita Verma is the chief investigator.

Figures

Fig. 1
Fig. 1. Kaplan–Meier survival in patients with refractory ascites who underwent liver transplant/TIPS, long-term abdominal drains or standard of care (large-volume paracentesis)
See this image and copyright information in PMC

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