Home-Based System Relieves Cirrhosis Refractory Ascites

A novel tunneled peritoneal catheter (PeCa) drainage system provided significant relief for patients with refractory ascites, according to a new study.

The PeCa implant, developed at Hannover Medical School (Germany), is composed of internal shut that lies in the peritoneal cavity, a tunneled section that passes through subcutaneous tissue, and an external port to which drainage bags are connected. To test system efficacy, outcomes in 152 patients with refractory ascites, who were not candidates for transjugular intrahepatic portosystemic shunt (TIPS) and received a PeCa implant, were compared to 71 patients who received standard care, which included repeated large volume paracentesis and albumin.

The results revealed that factors associated with 90-day survival were PeCa implantation, and each point of Model for End-Stage Liver Disease (MELD) score. Hospitalizations were more common in the PeCa group, for reasons that included spontaneous bacterial peritonitis (SBP), hyponatremia, and infections other than SBP. There was no significant difference in mortality between the two groups, but there were trends in the PeCa group towards higher frequency of acute kidney injury (AKI). The study was presented at the American Association for the Study of Liver Diseases annual conference, held online during November 2021.

“Patients with refractory ascites have a very high risk for rehospitalization, AKI, and death. Our data indicate that PeCa could be a valuable new treatment option for patients with refractory ascites and contraindication for TIPS,” said study co-author and presenter Tammo Lambert Tergast, MD. “I think if we can optimize the treatment after discharge, we can also minimize the rehospitalization in these patients. However, the risk for hyponatremia and AKI has to be considered and further explored.”

Refractory ascites occurs when patients no longer respond to medical therapy, a condition that affects over 100,000 patients in Europe and the United States every year, a number that is growing at approximately 10% a year. The primary treatment for ascites is paracentesis, a procedure in which a large bore needle is inserted into the patient's abdomen to remove between 5‐10 liters of ascites that has accumulated over a period of a week or two.

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