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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 8, 2016; 8(28): 1182-1193
Published online Oct 8, 2016. doi: 10.4254/wjh.v8.i28.1182
Management of refractory ascites in cirrhosis: Are we out of date?
Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Noureddin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen
Alagappan Annamalai, Lauren Wisdom, Megan Herada, Mazen Noureddin, Walid Ayoub, Vinay Sundaram, Andrew Klein, Nicholas Nissen, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Dr. Alagappan Annamalai, Comprehensive Transplant Center, Cedars Sinai Medical Center, 8900 Beverly Blvd, 2nd fl. Suite 262, Los Angeles, CA 90048, United States. alagappan.annamalai@cshs.org
Telephone: +1-310-4232975
Received: March 11, 2016
Peer-review started: March 14, 2016
First decision: April 20, 2016
Revised: July 22, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 8, 2016
Processing time: 201 Days and 10.3 Hours
Core Tip

Core tip: Few randomized control studies have been performed in the management of refractory ascites, of which all were performed either in the pre-model for end-stage liver disease (MELD) era or done in patients with low MELD scores. As such, most of the management guidelines have significant limitations in its utility for patients admitted to the hospital with significant hemodynamic dysfunction and other complications of cirrhosis. Our objective is to review the origins of our current management of refractory ascites and its limitations.