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World J Hepatol. Mar 27, 2021; 13(3): 300-314
Published online Mar 27, 2021. doi: 10.4254/wjh.v13.i3.300
Lymphatic dysfunction in advanced cirrhosis: Contextual perspective and clinical implications
Ramesh Kumar, Utpal Anand, Rajeev Nayan Priyadarshi
Ramesh Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Utpal Anand, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Rajeev Nayan Priyadarshi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Author contributions: Kumar R designed and wrote the manuscript, and collected relevant data; Anand U and Priyadarshi RN contributed in data collection and manuscript writing; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Associate Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Received: December 17, 2020
Peer-review started: December 17, 2020
First decision: January 25, 2021
Revised: January 31, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: March 27, 2021
Processing time: 92 Days and 8.6 Hours
Core Tip

Core Tip: Lymphatic dysfunction appears to play a significant role in the pathophysiology of advanced cirrhosis. Sustained portal hypertension, neurohormonal changes, and low-grade chronic inflammation have been implicated in causing lymphatic dysfunction in advanced cirrhosis, leading to worsening of ascites, lymphedema, and abnormal lipid transport; it also results in increased susceptibility to infections. Chylous ascites and intestinal lymphangiectasia are the rare manifestations of lymphatic dysfunction in cirrhosis, leading to loss of protein, fat, lymphocytes, and immunoglobins, with several clinical consequences. Lymphatic dysfunctions in cirrhosis have been ignored to date; hence, new exploratory research must be undertaken to gain insight into this important subject.