Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

作者：Tammo Lambert Tergast, Marie Griemsmann, Lena Stockhoff, Benjamin Heidrich, Hendrik Schirmer, Henrike Lenzen, Heiner H. Wedemeyer, Markus Cornberg, Elmar Jaeckel, Benjamin Maasoumy · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2022 · DOI：10.1111/apt.17066 · 被引用次数：16 · 研究领域：Liver Disease and Transplantation、Amoebic Infections and Treatments、Organ Transplantation Techniques and Outcomes

BACKGROUND: Onset of refractory ascites is the hallmark of end-stage liver disease. If liver transplantation (LTx) is not available and contraindications for a transjugular portosystemic shunt (TIPS) are present, repeated paracentesis remains the standard of care (SOC). Home-based, tunnelled peritoneal catheters (PeCa) have been suggested as an alternative treatment option. However, data on patients with cirrhosis are scarce. AIM: To evaluate the safety of PeCa in these patients compared to SOC. METHODS: Overall, 223 patients with cirrhosis, a contraindication for TIPS and refractory ascites were included in this retrospective study. PeCa implant was performed in 152 patients, whereas 71 were treated with SOC. Analysed end points included device explant-free survival, mortality, acute kidney injury (AKI) and hyponatraemia. In the second approach, propensity score matching (PPSM) was performed to adjust for confounding factors. RESULTS: In patients with PeCa, median device explant-free survival was 74 days and 52 explants were recorded within the first 90 days. Within 90 days, patients with PeCa had lower mortality than SOC (p = 0.11), and spontaneous bacterial peritonitis (SBP) incidence did not differ (p = 0.82). Regarding AKI and hyponatraemia, there was a trend towards a higher incidence in the PeCa group (p = 0.13 and p = 0.08), and the risk for rehospitalisation was higher in those with a PeCa (HR: 2.11, p = 0.04). After PPSM, mortality was lower in the PeCa group (HR:0....