title: Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis.
abstract: OBJECTIVE
  Refractory ascites has a poor prognosis. Recurrent large-volume paracentesis is the current standard of care; however, it results in circulatory dysfunction and renal dysfunction, and hospitalization is commonly required. Transjugular intrahepatic portosystemic shunt placement is not an option in a substantial number of patients because of contraindications. The placement of a tunneled peritoneal drainage catheter has been shown to be effective in patients with malignant ascites. However, data in patients with nonmalignant refractory ascites are rare.
  
  
  METHODS
  We followed 24 consecutive patients in whom tunneled peritoneal drainage catheters were placed in the Endoscopy Unit at Hannover Medical School between June 2013 and December 2014.
  
  
  RESULTS
  Catheters were placed in 24 patients with refractory ascites in end-stage liver disease and with a contraindication to transjugular intrahepatic portosystemic shunt placement. Placement was technically successful in all patients. The dosage of diuretics could be reduced significantly. The number of paracentesis decreased from 2.2±1 to 0 per week, although the volume of daily ascites removal remained stable (2 l). Despite frequent drainage of ascites, kidney function, serum sodium, and serum albumin remained stable. Seven adverse events occurred in six (25%) patients. Five patients listed for liver transplantation underwent successful transplantation without a negative impact.
  
  
  CONCLUSIONS
  The tunneled peritoneal drainage catheter placement is a viable and effective treatment alternative in patients with refractory ascites because of end-stage liver disease, reducing diuretic intake and the need for paracentesis. The procedure avoids hyponatremia, worsening kidney function, and albumin infusions without an increased risk of spontaneous bacterial peritonitis.
authors.affiliation: aDepartment of Gastroenterology, Hepatology and Endocrinology bInstitute for Medical Microbiology and Hospital Epidemiology, Hannover cGerman Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Braunschweig, Germany dInstitute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover.
authors.forename: Philipp
authors.initials: P
authors.lastname: Solbach
authors.forename: Christoph
authors.initials: C
authors.lastname: Höner Zu Siederdissen
authors.forename: Richard
authors.initials: R
authors.lastname: Taubert
authors.forename: Szilvia
authors.initials: S
authors.lastname: Ziegert
authors.forename: Kerstin
authors.initials: K
authors.lastname: Port
authors.forename: Andrea
authors.initials: A
authors.lastname: Schneider
authors.forename: Katja
authors.initials: K
authors.lastname: Hueper
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: Elmar
authors.initials: E
authors.lastname: Jaeckel
mesh_terms: D000368:Aged; D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D004232:Diuretics / Q000008:administration & dosage; D004322:Drainage / Q000379:methods; D004334:Drug Administration Schedule; D058625:End Stage Liver Disease / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D004232:Diuretics