PleurX™ catheter for management of refractory ascites in cirrhosis: A prospective pilot study

Abstract Background: Refractory ascites is a common complication of decompensated cirrhosis. While some patients with this condition are candidates for liver transplant or transjugular intrahepatic portosystemic shunt (TIPS), most require repeated large-volume paracentesis (LVP). Tunnelled peritoneal catheters (TPCs) are an emerging option, though evidence in cirrhosis remains limited. This prospective single-arm exploratory pilot study evaluated symptoms, quality of life (QOL), nutrition, and clinical outcomes in patients with cirrhosis and TPC-managed RA. Methods: In 2016–2019, adults with cirrhosis and RA undergoing paracentesis every 1–2 weeks, with a life expectancy ≥6 months, were enrolled at a tertiary liver centre (12 enrolments, 11 unique patients). Patients eligible for liver transplant or TIPS, on immunosuppression, or with loculated ascites were excluded. Baseline assessments were performed at the final LVP before PleurX™ TPC insertion, with evaluations over 24 weeks. Results: Protein and calorie intake increased within 30 days of TPC insertion and remained at or above baseline. Appetite and handgrip strength improved, peaking at 17 weeks. Abdominal symptoms and QOL scores improved and remained higher than baseline at 6 months. Wellness scores were variable but remained at or above baseline through month 5. One participant (8.3%) developed peritonitis. Renal dysfunction requiring outpatient albumin occurred in 7 (58%) participants, and 2 (17%) were hospitalized with acute kidney injury; all improved with supportive management. Conclusions: In carefully selected patients with cirrhosis and RA, hypothesis-generating trends to improved symptoms and nutritional measures were seen with TPC. The frequency of renal dysfunction underscores the need for individualized management and further controlled studies.