Progress in treatment of massive ascites and hepatorenal syndrome

Table 1 Definition of refractory and recurrent ascites according to the consensus of the International Ascites Club[9]

Refractory ascites	cannot be mobilized by diuretics because of a lack of response (mean weight loss less than 200g/d during the last 4 d) or the development of diuretic-induced complications such as hyponatremia, hypokalemia, renal impairment, hepatic encephalopathy, precluding an effective diuretic dosage
Recidivant ascites	recurs at least on 3 occasions within 1 year despite prescription of dietary sodium restriction and adequate diuretic dosage

Table 2 Important features of large prospective trials[11-14] comparing TIPS with paracentesis for massive ascites

	Rossle[11]	Gines[12]	Sanyal[13]	Salerno[14]
Patients/selected from pts.	60/155	70/119	109/525	66/137
Complete response (%)	79 vs 24	51 vs 17	58 vs 16	61 vs 3
Survival benefit of TIPS	yes	no	trend	yes
Number of centers	2	≥5	6	3
Child-Pugh C (%)	38	37	?	76
Athyltox. Zirrhose (%)	79	51	62	42
Severe encephalop. (%)	23 vs 13	60 vs 34	29 vs 18	61 vs 39
Mean TIPS Ø (mm)	9	8→10	10	?

Table 3 Serum bilirubin concentration at study inclusion and during follow-up (μmol/L, mean±SD)

	Rossle[11]	Gines [12]	Sanyal [13]	Salerno [14]
Cut-off for study inclusion	5	10	5	6
Baseline	1.7 ± 0.2	2.0 ± 0.2	1.9 ± 0.2	1.6 ± 0.1
Follow-up(mo)	2.9 ± 0.9	4.6 ± 2.0	2.2 ± 2.1	2.1 ± 0.2

Table 4 Definition of hepatorenal syndrome according to the consensus of the International Ascites Club[9]

HRS Type 1: Rapidly progressing renal failure (< 2 wk) ≥ 2-fold increase of serum creatinine to > 221μmol/L or 50% decrease of creatinine clearance to < 20mL/min

HRS Type 2: Not rapidly progressing renal failure

Serum creatinine > 132.6 μmol/L or

Creatinine clearance < 40mL/min

Absence of shock, ongoing bacterial infection, current or recent treatment with nephrotoxic drugs, gastrointestinal or renal fluid loss

No sustained improvement upon withdrawal of diuretics and plasma volume expansion

Proteinuria < 0.5g/d, no abnormalities of renal ultrasound