title: Management of refractory ascites in cirrhosis: Are we out of date?
abstract: Cirrhosis is a major cause of morbidity and mortality worldwide with liver transplantations as it only possible cure. In the face of a significant organ shortage many patients die waiting. A major complication of cirrhosis is the development of portal hypertension and ascites. The management of ascites has barely evolved over the last hundred years and includes only a few milestones in our treatment approach, but has overall significantly improved patient morbidity and survival. Our mainstay to ascites management includes changes in diet, diuretics, shunt procedures, and large volume paracentesis. The understanding of the pathophysiology of cirrhosis and portal hypertension has significantly improved in the last couple of decades but the changes in ascites management have not seemed to mirror this newer knowledge. We herein review the history of ascites management and discuss some its current limitations.
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Alagappan
authors.initials: A
authors.lastname: Annamalai
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Lauren
authors.initials: L
authors.lastname: Wisdom
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Megan
authors.initials: M
authors.lastname: Herada
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Mazen
authors.initials: M
authors.lastname: Nourredin
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Walid
authors.initials: W
authors.lastname: Ayoub
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.affiliation: Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Nourredin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Nissen
keywords: Ascites; Cirrhosis; Paracentesis; Portal hypertension; Transhepatic portosystemic shunts