P47 A single centre experience in using a tunnelled indwelling catheter (PleurX) drain for patients with large volume refractory ascites from decompensated cirrhosis

<h3>Introduction</h3> Ascites is the most common complication of liver cirrhosis requiring hospitalisations. Refractory ascites is defined as the presence of ascites in patients who are intolerant or resistant to medical therapy such as diuretics. Once the ascites becomes refractory, the median transplant free survival is around 6 months. Serial or regular large volume paracentesis remains the common form of treatment for those with refractory ascites. The other treatment options include TIPS (transjugular intrahepatic portosystemic stent/shunt) and indwelling tunnelled peritoneal drains (PleurX catheter). <h3>Methods</h3> The data were collected retrospectively from the patients who had tunnelled drain between 2019 and 2023. <h3>Results</h3> 13 patients had PleurX drain during the 5-year period. Majority were male (54%) and Caucasian (92%). 12 patients died (92%) during the study period. The median age at death was 68 years (range 47 -87). The common causes of liver disease were alcohol related liver disease (n=5) and metabolic dysfunction-associated steatotic liver disease (MASLD) (n=5). Five patients had concurrent hepatocellular carcinoma. Among 13 patients, a total of 17 drains were inserted. Seven drains were inserted electively. Four patients required the 2nd drain insertion due to these reasons (drain dislodge n=1, not draining n=3). The median number of days between 2 drains were 23 (range: 12–265 days). For those who had the drain during the hospital admission, the median number of days stayed as inpatient was 15 days (range: 4 and 72). Two drains were removed due to spontaneous bacterial peritonitis (SBP) (n=1, days 49 post insertion) and blockage (n=1, days 265 post insertion). None of the patients had SBP prior to drain insertion but 2 patients (15%) developed SBP post drain. Among those patients who developed SBP, only one patient had prophylactic antibiotics post drain insertion. The median days between drain and death was 54 (range 12–159). Most patients (69%) died within 3 months of the drain insertion. <h3>Conclusions</h3> The development of refractory ascites in end stage liver disease is a difficult time for the patients and their caregivers. Although LVP is an effective treatment option, the patients required frequent hospital visits that can be costly as well as time consuming. Tunnelled peritoneal drains for refractory ascites is an option who wish to spend more time in the comfort of their home during their terminal or palliative phase of their illness. The key is to have a collaborative multidisciplinary approach between hospital teams, community, primary care, patients and their caregivers.