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Portal Hypertension pp 301–317Cite as

Management of Ascites

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Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Abnormal renal sodium handling is an early and common complication of liver cirrhosis and eventually results in ascites formation. At least 50% of patients will develop ascites within 10 yr of diagnosis of cirrhosis (1). The presence of ascites predisposes the cirrhotic patients to further complications such as the development of spontaneous bacterial peritonitis and renal impairment, which significantly worsens the prognosis of these patients. The presence of ascites is also an indication for liver transplantation. Therefore, effective management of ascites is essential for improving the well being and survival of these patients.

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References

  1. Gines P, Quintero E, Arroyo V, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology 1987;7:122–128.

    Article  PubMed  CAS  Google Scholar 

  2. Reynolds TB, Geller HM, Kuzma OT, Redeker AG. Spontaneous decrease in portal pressure with clinical improvement in cirrhosis. N Engl J Med 1960;263:734–739.

    Article  PubMed  CAS  Google Scholar 

  3. Loguercio C, Di Pierro M, Di Marino MP, et al. Drinking habits of subjects with hepatitis C virus-related chronic liver disease: prevalence and effect on clinical, virological and pathological aspects. Alcohol Alcohol 2000;35:296–301.

    PubMed  CAS  Google Scholar 

  4. Villeneuve J-P, Condreay LD, Willems B, et al. Lamivudine treatment for decompensated cirrhosis due to chronic hepatitis B. Hepatology 2000;31:207–210.

    Article  PubMed  CAS  Google Scholar 

  5. Wong F, Liu P, Blendis LM. The mechanism of improved sodium homeostasis of low-dose losartan in pre-ascitic cirrhosis. Hepatology 2002;35:1449–1458.

    Article  PubMed  CAS  Google Scholar 

  6. Trcvisani F, Bernardi M, Gasbarrini A, et al. Bed-rest-induced hypcmatriurcsis in cirrhotic patients without ascites: does it contribute to maintain ‘compensation’? J Hepatol 1992;16:190–196.

    Article  Google Scholar 

  7. Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology 1998;27:264–272.

    Article  PubMed  CAS  Google Scholar 

  8. Moore KP, Wong F, Gines P, et al. The management of ascites—Report on the consensus conference of the International Ascites Club. Hepatology 2003;38:258–266.

    Article  PubMed  Google Scholar 

  9. Descos L, Gauthier A, Levy VG, et al. Comparison of six treatments of ascites in patients with liver cirrhosis. A clinical trial. Hepatogastroenterology 1983;30:15–20.

    PubMed  CAS  Google Scholar 

  10. Gauthier A, Levy VG, Quinton A, et al. Salt or no salt in the treatment of cirrhotic ascites: a randomised study. Gut 1986;27:705–709.

    Article  PubMed  CAS  Google Scholar 

  11. Arroyo V, Ginès P, Saló J. A European survey on the treatment of ascites in cirrhosis. J Hepatol 1994;21:667–672.

    Article  PubMed  CAS  Google Scholar 

  12. Gregory P, Broekelschen PH, Hill MD. Complications of diuresis in the alcoholic patient with ascites, a randomized controlled trial. Gastroenterology 1977;73:534–538.

    PubMed  CAS  Google Scholar 

  13. Wilkinson SP, Jowett TP, Slater JD, Arroyo V, Moodie II, Williams R. Renal sodium retention in cirrhosis: relation to aldosterone and ncphron site. Clin Sci 1979;56:169–177.

    PubMed  CAS  Google Scholar 

  14. Salerno F, Angeli P, Bernardi M, Laffi G, Riggio O, Salvagnini M. Clinical practice guidelines for the management of cirrhotic patients with ascites. Ital J Gastroenterol Hepatol 1999;31:626–634.

    PubMed  CAS  Google Scholar 

  15. Fogel MR, Sawhney VK, Neal EA, Miller RG, Knauer CM, Gregory PB. Diuresis in the ascitic patient: a randomized controlled trial of three regimens. J Clin Gastroenterol 1981;3(Suppl 1):73–80.

    Article  PubMed  Google Scholar 

  16. Gentilini P. Spironolactone and canrenoate: different antialdosteronic diuretic agents. Hepatology 1991;13:999–1000.

    Article  PubMed  CAS  Google Scholar 

  17. Angeli P, Pria MD, De Bei E, et al. Randomized clinical study of the efficacy of amilorde and potassium canrenoate in nonazotemic cirrhotic patients with ascites. Hepatology 1994;19:72–79.

    PubMed  CAS  Google Scholar 

  18. Perez-Ayuso RM, Arroyo V, Planas R, et al. Randomized comparative study of efficacy of furosemide vs. spironolactone in nonazotemic cirrhosis with ascites. Gastroenterology 1983;84:961–968.

    PubMed  CAS  Google Scholar 

  19. Yagi N, Kiuchi T, Satoh IT, et al. Bioavailability and diuretic effect of furoscmidc following administration of tablets and retarded capsules to human subjects. Biol Pharm Bull 1996;19:616–622.

    PubMed  CAS  Google Scholar 

  20. Bernardi M, De Palma R, Trevisani F, et al. Effects of a new loop diuretic (muzolimine) in cirrhosis with ascites: comparison with furosemide. Hepatology 1986;6:400–405.

    Article  PubMed  CAS  Google Scholar 

  21. Pockros PJ, Reynolds TB. Rapid diuresis in patients with ascites from chronic liver disease: the importance of peripheral edema. Gastroenterology 1986;90:1827–1833.

    PubMed  CAS  Google Scholar 

  22. Laffi G, Marra F, Buzzelli G, et al. Comparison of the effects of torasemide and furosemide in nonazotemic cirrhotic patients with ascites: a randomized, double-blind study. Hepatology 1991;13:1101–1105.

    PubMed  CAS  Google Scholar 

  23. Morali GA, Tobe SW, Skorecki KL, Blendis LM. Refractory ascites: modulation of atrial natriuretic factor unresponsiveness by mannitol. Hepatology 1992;16:42–48.

    Article  PubMed  CAS  Google Scholar 

  24. Abraham WT, Lauwaars ME, Kim JK, Pena RL, Schrier RW. Reversal of atrial natriuretic peptide resistance by increasing distal tubular sodium delivery’ in patients with decompensated cirrhosis. Hepatology 1995;22:737–743.

    PubMed  CAS  Google Scholar 

  25. Sica DA, Gelr TW. Diuretic combinations in refractory oedema states: pharmacokinetic-pharmaco-dynamic relationships. Clin Pharmacokinet 1996;30:229–249.

    PubMed  CAS  Google Scholar 

  26. Gentilini P, Casini-Raggi V, Di Fiore G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol 1999;30:639–645.

    Article  PubMed  CAS  Google Scholar 

  27. Laffi G, Gentilini P, Romanelli RG, La Villa G. Ts the use of albumin of value in the treatment of ascites in cirrhosis? The case in favour. Dig Liver Dis 2003;35:660–663.

    Article  PubMed  CAS  Google Scholar 

  28. Gatta A, Angeli P, Caregaro L, Menon F, Sacerdoti D, Merkel C. A pathophysiological interpretation of unresponsiveness to spironolactone in a stepped-care approach to the diuretic treatment of ascites in nonazotemic cirrhotic patients. Hepatology 1991;14:231–236.

    PubMed  CAS  Google Scholar 

  29. Yeung E, Wong F. The management of cirrhotic ascites. Medscape Gastroenterology eJoumal 2002;4:8.

    Google Scholar 

  30. Sherman DS, Fish DN, Teitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis 2003;41:269–278.

    Article  PubMed  CAS  Google Scholar 

  31. Caregaro L, Menon F, Angeli P, et al. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med 1994;154:201–205.

    Article  PubMed  CAS  Google Scholar 

  32. Arroyo V, Rodes J, Gutierrez-Lizarraga MA, Revert L. Prognostic value of spontaneous hyponatremia in cirrhosis with ascites. Am J Dig Dis 1976;21:249–256.

    Article  PubMed  CAS  Google Scholar 

  33. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J. Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988;8:1151–1157.

    Article  PubMed  CAS  Google Scholar 

  34. Gines P, Bernardi M, Bichet DG, et al. Hyponatremia in cirrhosis: from pathogenesis to treatment. Hepatology 1998;28:851–864.

    Article  PubMed  CAS  Google Scholar 

  35. Laurcno R, Karp BI. Myelinoly sis after correction of hyponatremia. Ann Intern Med 1997;126:57–62.

    Google Scholar 

  36. Gadano A, Moreau R, Pessione F, et al. Aquaretic effects of niravoline, a k-opioid agonist, in patients with cirrhosis. J Hepatology 2000;32:38–42.

    Article  CAS  Google Scholar 

  37. Wong F, Blei AT, Blendis L, Thuluvath P. A vasopressin receptor antagonist (VPA-985) improves serum sodium concentration in patients with hyponatremia: a multicenter, randomized, placebo-controlled trial. Hepatology 2003;37:182–191.

    Article  PubMed  CAS  Google Scholar 

  38. Gerbes AL, Gulberg V, Gines P, et al. VPA Study Group. Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial. Gastroenterology 2003;124:933–939.

    Article  PubMed  CAS  Google Scholar 

  39. Arroyo V, Gines P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996;23:164–176.

    Article  PubMed  CAS  Google Scholar 

  40. Gines P, Arroyo V, Quintero E, et al. Comparison of paracentesis and diuretics in the treatment of cirrhosis with tense ascites: results of a randomized study. Gastroenterology 1987;93:234–241.

    PubMed  CAS  Google Scholar 

  41. Salerno F, Badalamenti S, Incerti P, et al. Repeated paracentesis and i.v. albumin infusion to treat ‘tense’ ascites in ascitic patients: a safe alternative therapy. J Hepatol 1987;5:102–108.

    Article  PubMed  CAS  Google Scholar 

  42. Pinto PC, Amerian J, Reynolds TB. Large volume paracentesis in non-edematous patients with tense ascites: its effect on intravascular volume. Hepatology 1988;8:207–210.

    Article  PubMed  CAS  Google Scholar 

  43. Gines P, Tito L, Arroyo V, et al. Randomized comparative study of therapeutic parcentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;94:1493–1502.

    PubMed  CAS  Google Scholar 

  44. Jeffries MA, Stern MA, Gunaratnam NT, Fontana RJ. Unsuspected infection is infrequent in asymptomatic outpatients with refractory ascites undergoing therapeutic paracentesis. Am J Gastroenterol 1999;94:2972–2976.

    Article  PubMed  CAS  Google Scholar 

  45. Pascual S, Such J, Perez-Mateo M. Spontaneous bacterial peritonitis and refractory ascites. Am J Gastroenterol 2000;95:3686–3687.

    Article  PubMed  CAS  Google Scholar 

  46. Evans LT, Kim WR, Poterucha JJ, Kamath PS. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003;37:897–901.

    Article  PubMed  Google Scholar 

  47. Sola R, Andreu M, Coll S, Vila MC, Oliver MI, Arroyo V. Spontaneous bacterial peritonitis in cirrhotic patients treatedusing paracentesis or diuretics: results of a randomized study. Hepatology 1995;21:340–344.

    PubMed  CAS  Google Scholar 

  48. Runyon BA. Paracentesis of ascitic fluid. Arch Intern Med 1986;146:2259–2261.

    Article  PubMed  CAS  Google Scholar 

  49. Webster ST, Brown KL, Lucey MR, Nostrant TT. Hemorrhagic complications of large volume abdominal paracentesis. Am J Gastroenterol 1996;91:366–368.

    PubMed  CAS  Google Scholar 

  50. Oelsner DH, Caldweel SH, Coles M, Driscoll CJ. Subumbilical midline vascularity of the abdominal wall in portal hypertension observed at laparoscopy. Gastrointest Endosc 1998;47:388–390.

    Article  PubMed  CAS  Google Scholar 

  51. Martinet O, Reis ED, Mosimann F. Delayed hemoperitoneum following large-volume paracentesis in a patient with cirrhosis and ascites. Digest Dis Sci 2000;45:357–358.

    Article  PubMed  CAS  Google Scholar 

  52. Kravctz D, Romero G, Argonz J, et al. Total volume paracentesis decreases variccal pressure, size, and variceal wall tension in cirrhotic patients. Hepatology 1997;25:59–62.

    Article  Google Scholar 

  53. Luca A, Feu F, Garcia-Pagan JC, et al. Favorable effects of total paracentesis on splanchnic hemodynamics in cirrhotic patients with tense ascites. Hepatology 1994;20:30–33.

    PubMed  CAS  Google Scholar 

  54. McVay PA, Toy PT. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion 1991;31:164–171.

    Article  PubMed  CAS  Google Scholar 

  55. Ginès A, Fernandez-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002–1010.

    Article  PubMed  Google Scholar 

  56. Altaian C, Bernard B, Roulot D, Vitte RL, Ink O. Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis. Eur J Gastroenterol Hepatol 1998;10:5–10.

    Article  Google Scholar 

  57. Planas R, Ginès P, Arroyo V, et al. Dextran-70 versus albumin as plasma expanders in cirrhotic patients with ascites treated with total paracentesis. Results of a randomized study. Gastroenterology 1990;99:1736–1744.

    PubMed  CAS  Google Scholar 

  58. Salerno F, Badalamenti S, Lorenzano E, Moser P, Incerti P. Randomized comparative study of hemaccel vs albumin infusion after total paracentesis in cirrhotic patients with refractory ascites. Hepatology 1991;13:707–713.

    PubMed  CAS  Google Scholar 

  59. Fassio E, Terg R, Landeira G, et al. Paracentesis with dextran 70 vs paracentesis with albumin in cirrhosis with tense ascites. Results of a randomized study. J Hepatol 1992;14:310–316.

    Article  PubMed  CAS  Google Scholar 

  60. Sola-Vera J, Minana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction incirrhotic patients with ascites. Hepatology 2003;37:1147–1153.

    Article  PubMed  CAS  Google Scholar 

  61. Peltekian K, Wong F, Liu P, Allidina Y, Sherman M, Blendis LM. The effect of large volume paracentesis on total central blood volume, systemic and renal hemodynamics and renal sodium handling in cirrhosis. Am J Gastroenterology 1997;92:394–399.

    CAS  Google Scholar 

  62. Moller S, Bendtsen F, Henriksen JH. Effect of volume expansion on systemic hemodynamics and central and arterial blood volume in cirrhosis. Gastreonterology 1995;109:1917–1925.

    Article  CAS  Google Scholar 

  63. Rothschild M, Oratz M, Evans C, Schreiber SS. Alterations in albumin metabolism after serum and albumin infusions. J Clin Invest 1964;43:1874–1880.

    Article  PubMed  CAS  Google Scholar 

  64. Arroyo V, Colmenero J. Use of albumin in the management of patients with decompensated cirrhosis. An independent verdict. Dig Liver Dis 2003;35:668–672.

    Article  PubMed  CAS  Google Scholar 

  65. Tito L, Gines P, Arroyo V, et al. Total paracentesis associated with intravenous albumin management of patients with cirrhosis and ascites. Gastroenterology 1990;98:146–151.

    PubMed  CAS  Google Scholar 

  66. Vila MC, Coll S, Sola R, Andreu M, Gana J, Marquez J. Total paracentesis in cirrhotic patients with tense ascites and dilutional hyponatremia. Am J Gastroenterol 1999;94:2219–2223.

    Article  PubMed  CAS  Google Scholar 

  67. Vila MC, Sola R, Molina L, et al. Hemodynamic changes in patients developing effective hypovolemia after total paracentesis. J Hepatol 1998;28:639–645.

    Article  PubMed  CAS  Google Scholar 

  68. Ruiz-del-Arbol L, Monescillo A, Jimenez W, Garcia-Plaza A, Arroyo V, Rodes J. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997;113:579–586.

    Article  PubMed  CAS  Google Scholar 

  69. Luca A, Garcia-Pagan JC, Bosch J, et al. Beneficial effects of intravenous albumin infusion on the hemodynamic and humoral changes after total paracentesis. Hepatology 1995;22:753–758.

    PubMed  CAS  Google Scholar 

  70. Morali GA, Snidennan KW, Deitel KM, et al. Is sinusoidal portal hypertension a necessary factor for the development of hepatic ascites. J Hepatology 1992;16:249–250.

    Article  CAS  Google Scholar 

  71. Jalan R, Hayes PC. Sodium handling in patients with well compensated cirrhosis is dependent on the severity of liver disease and portal pressure. Gut 2000;46:527–533.

    Article  PubMed  CAS  Google Scholar 

  72. Jalan R, Forrest EH, Redhead DN, Dillon JF, Hayes PC. Reduction in renal blood flow following acute increase in the portal pressure: evidence for the existence of a hepatorenal reflex in man? Gut 1997;40:664–670.

    PubMed  CAS  Google Scholar 

  73. Orloff MJ. Surgical treatment of intractable cirrhotic ascites. Ann Surg 1966;164:69–80.

    Article  PubMed  CAS  Google Scholar 

  74. Colapinto RF, Stronell RD, Birch SJ, et al. Creation of an intrahepatic portosystemic shunt with a Grantzig balloon catheter. Can Med Assoc J 1982;126:267–268.

    PubMed  CAS  Google Scholar 

  75. Richter GM, Noeldge G, Palmaz JC, Roessle M. The transiugular intrahepatic portosystemic stent-shunt (TTPSS): results of a pilot study. Cardiovasc Intervent Radiol 1990;13:200–207.

    Article  PubMed  CAS  Google Scholar 

  76. Gordon ID, Colapinto RF, Abecassis M, et al. Transiugular intrahepatic portosystemic shunt: a non-operative approach to life-threatening variceal bleeding. Can J Surg 1987;30:45–49.

    PubMed  CAS  Google Scholar 

  77. Russo MW, Sood A, Jacobson IM, Brown RS Jr. Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Am J Gastroenterol 2003;98:2521–2527.

    Article  PubMed  Google Scholar 

  78. Wong F, Sniderman K, Liu P, Blendis LM. The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt. Gaslroenterology 1997;112:899–907.

    Article  CAS  Google Scholar 

  79. Wong F, Sniderman K, Liu P, Allidina Y, Sherman M, Blendis LM. The effects of transjugular intrahepatic portasystemic shunt on systemic and renal hemodynamics and sodium homeostasis in cirrhotic patients with refractory ascites. Ann Int Med 1995;122:816–822.

    PubMed  CAS  Google Scholar 

  80. Wong W, Liu P, Blendis LM, Wong F. Renal sodium handling during long-term follow-up and the effect of sodium loading in cirrhotic patients treated with TIPS for refractory ascites. Am J Med 1999;106:315–322.

    Article  PubMed  CAS  Google Scholar 

  81. Allard JP, Chau J, Sandokji AM, Blendis L, Wong F. Effects of transjugular intrahepatic portosystemic shunt (TIPS) on the nutritional status of cirrhotic patients with refractory ascites. Am J Gastroenterology 2001;96:2442–2447.

    Article  CAS  Google Scholar 

  82. Zhuang ZW, Teng GJ, Jeffery RF, Gemery JM, Janne d’Othee B, Bettmann MA. Long-term results and quality of life in patients treated with transjugular intrahepatic portosystemic shunts. AJR 2002;179:1597–1603.

    PubMed  Google Scholar 

  83. Gulberg V, Liss I, Bilzer M, Waggershauser T, Reiser M, Gerbes AL. Improved quality of life in patients with refractory or recidivant ascites after insertion of transjugular intrahepatic portosystemic shunts. Digestion 2002;66:127–130.

    Article  PubMed  Google Scholar 

  84. Lebrec D, Giuily N, Hadenque A, et al. Transjugular intrahepatic portosystemic shunt: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. J Hepatology 1996;25:135–144.

    Article  CAS  Google Scholar 

  85. Rossle M, Ochs A, Gulberg V, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 2000;342:1701–1707.

    Article  PubMed  CAS  Google Scholar 

  86. Sanyal A, Gennings C, Reddy KR, et al. A randomized controlled study of TIPS versus large volume paracentesis in the treatment of refractory ascites. Gastroenterology 2003;124:634–643.

    Article  PubMed  Google Scholar 

  87. Gines P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunt versus repeated paracentesis plus intravenous albumin for refractory ascites in cirrhosis. A multicenter randomized comparative study. Gastroenterology 2002;123:1839–1847.

    Article  PubMed  Google Scholar 

  88. Salerno F, Merli M, Riggio O, et al. Randomized controlled study of TIPS vs. Paracentesis plus albumin in cirrhosis with severe ascites. Hepatology 2004;40:629–635.

    Article  PubMed  CAS  Google Scholar 

  89. Walser E, Ozkan OS, Raza S, Soloway R, Gajula L. Hepatic perfusion as a predictor of mortality after transjugular intrahepatic portosystemic shunt creation in patients with refractory ascites. J Vasc Interv Radiol 2003;14:1251–1257.

    PubMed  Google Scholar 

  90. Deschenes M, Dufresne MP, Bao B, et al. Predictors of clinical response to transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with refractory ascites. Am J Gastroenterol 1999;94:1361–1365.

    PubMed  CAS  Google Scholar 

  91. Brensing KA, Textor J, Perz J, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut 2000;47:288–295.

    Article  PubMed  CAS  Google Scholar 

  92. Wong F, Blendis L. Transjugular intrahepatic portosystemic shunt for refractory ascites: tipping the sodium balance. Hepatology 1995;22:358–364.

    PubMed  CAS  Google Scholar 

  93. Huonker M, Schumacher YO, Ochs A, Sorichter S, Keul J, Rossle M. Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt. Gut 1999;44:743–748.

    Article  PubMed  CAS  Google Scholar 

  94. Freedman AM, Sanyal AJ, Tisnado J, et al. Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review. Radiographics 1993;13:1185–1210.

    PubMed  CAS  Google Scholar 

  95. Sanyal AJ, Freedman AM, Purdum PP, Shiffman ML, Luketic VA. The hematologic consequences of transjugular intrahepatic portosystemic shunts. Hepatology 1996;23:32–39.

    Article  PubMed  CAS  Google Scholar 

  96. Sanyal AJ, Freedman AM, Shiffman ML, Purdum PP III, Luketic VA, Cheatham AK. Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatology 1994;20:46–55.

    PubMed  CAS  Google Scholar 

  97. Madoff DC, Perez-Young IV, Wallace MJ, Skolkin MD, Toombs BD. Management of TIPS-related refractory hepatic encephalopathy with reduced Wallgraft endoprostheses. J Vase Interv Radiol 2003;14:369–374.

    Google Scholar 

  98. Kerlan RK Jr, LaBerge JM, Gordon RL, Ring FJ. Transjugular intrahepatic portosystemic shunts: current status. AJR 1995;164:1059–1066.

    PubMed  Google Scholar 

  99. Otal P, Smayra T, Bureau C, et al. Preliminary results of a new expanded-polytetrafluoroethylene-covered stent-grafl for transjugular intrahepatic portosystemic shunt procedures. AJR 2002;178:141–147.

    PubMed  Google Scholar 

  100. D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci 1986;31:468–475.

    Article  PubMed  CAS  Google Scholar 

  101. Carilhers RL. Liver transplantation. Liver Transpl 2000;6:122–135.

    Article  Google Scholar 

  102. Forns X, Gines A, Gines P, Arroyo V. Management of ascites and renal failure in cirrhotics. Semin Liver Dis 1994;14:82–96.

    Article  PubMed  CAS  Google Scholar 

  103. Gonwa TA, Klintmalm GB, Levy M, Jennings LS, Goldstein RM, Husberg BS. Impact of pretransplant renal function on survival after liver transplantation. Transplantation 1995;59:361–365.

    Article  PubMed  CAS  Google Scholar 

  104. Brown RS, Lombardero M, Lake JR. Outcome of patients with renal insufficiency undergoing liver or liver-kidney transplantation. Transplantation 1996;62:1788–1793.

    Article  PubMed  Google Scholar 

  105. Lafayette RA, Pare G, Schmid CH, King AJ, Rohrer RJ, Nasraway SA. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation. Clin Nephrol 1997;48:159–164.

    PubMed  CAS  Google Scholar 

  106. Thalheimer U, Capra F. Liver transplantation: making the best out of what we have. Dig Dis Sci 2000;47:945–953.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, University of Toronto, Toronto General Hospital, Ontario, Canada

    Florence Wong MD

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  1. Florence Wong MD
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Editors and Affiliations

  1. Division of Gastroenterology, Virginia Commonwealth Medical Center, Richmond, VA

    Arun J. Sanyal MBBS, MD

  2. GI Research Unit, Mayo Clinic, Rochester, MN

    Vijay H. Shah MD

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Wong, F. (2005). Management of Ascites. In: Sanyal, A.J., Shah, V.H. (eds) Portal Hypertension. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59259-885-4_20

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