Home Management of Refractory Ascites in Decompensated Cirrhosis With Long-Term Abdominal Drains, a Pilot Study

The prevalence of decompensated liver cirrhosis (DC) is increasing worldwide. Ascites-related readmissions are the predominant cause of hospitalizations in DC . Refractory ascites (RA), characterized by diuretic non-responsiveness or intolerance, is encountered in 10% of patients with cirrhosis and is associated with reduced survival without liver transplantation (LT) or trans-jugular intrahepatic portosystemic shunts (TIPSS). Large volume paracentesis (LVP) and albumin infusions are the only therapeutic options in those with RA who cannot undergo LT or TIPSS. LVPs are often required weekly or fortnightly, placing significant burden on hospital systems and often leading to unplanned hospitalizations. These recurrent admissions, with adverse impacts on patients' quality of life (QoL) and health expenditure, are potentially avoidable if ascites drainage can be regularly performed in patients' homes. Since ascites drainage in patients unsuitable for LT is a palliative procedure, it is best approached along principles of palliative care. Drainage using indwelling catheters is a well-accepted model of care in patients with malignant ascites and hydrothorax. There is limited evidence supporting this procedure in cirrhotic patients with RA]. The aim of this study was therefore to explore the feasibility, effectiveness, safety, and acceptability of home drainage of ascites with long-term abdominal drains (LTAD) in an Australian health care setting as a management pathway for RA. The complete study protocol is included as Supporting Information, Section 1.