Author information
1 Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Room 222, 9th floor, Eaton Wing, Toronto, Ontario M5G2C4, Canada.
2 Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Room 222, 9th floor, Eaton Wing, Toronto, Ontario M5G2C4, Canada. Electronic address: florence.wong@utoronto.ca.
Abstract
Ascites occurs in up to 70% of patients during the natural history of cirrhosis. Management of uncomplicated ascites includes sodium restriction and diuretic therapy, whereas that for refractory ascites (RA) is regular large-volume paracentesis with transjugular intrahepatic portosystemic shunt being offered in appropriate patients. Renal impairment occurs in up to 50% of patients with RA with type 1 hepatorenal syndrome (HRS) being most severe. Liver transplant remains the definitive treatment of eligible candidates with HRS, whereas combined liver and kidney transplant should be considered in patients requiring dialysis for more than 4 to 6 weeks or those with underlying chronic kidney disease.