Published online Oct 27, 2023. doi: 10.4254/wjh.v15.i10.1140
Peer-review started: August 17, 2023
First decision: September 5, 2023
Revised: September 14, 2023
Accepted: October 8, 2023
Article in press: October 8, 2023
Published online: October 27, 2023
Processing time: 67 Days and 14.4 Hours
Lymphatic dysfunction occurs in patients with liver cirrhosis, although the published data on this subject is extremely limited. Given the significant role the lymphatic system plays in maintaining the balance of body fluids, it is reasonable to assume that a dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.
From a therapeutic standpoint, it can be extremely important to evaluate lymphatic dysfunction in cirrhosis patients with refractory ascites (RA) since it would call for using different strategies for fluid mobilization.
The objectives of this study were to assess the magnitude, spectrum, and clinical associations of lymphatic dysfunction in cirrhosis patients with RA using surrogate markers such as lymphedema, intestinal lymphangiectasia (IL), and chylous ascites (CA).
This observational study was conducted as an exploratory project with a cross-sectional design and included 155 consecutive cirrhosis patients with RA. The presence of clinical signs of lymphedema, IL on duodenal biopsy, and CA were used as surrogate markers of lymphatic dysfunction.
The study found evidence of lymphatic dysfunction in nearly half of the cirrhosis patients with RA. The spectrum of dysfunction included peripheral lymphedema in 33.5%, intestinal IL in 27.0%, and CA in 1.3%. Obesity, lymphocytopenia, and hypoproteinemia were independently associated with the presence of lymphatic dysfunction in such patients.
Lymphatic dysfunction is common in cirrhosis patients with RA. Hypoproteinemia and lymphocytopenia are significant indicators of its presence.
Evaluation of lymphatic dysfunction in cirrhosis patients with RA can serve as a guide for future research into novel approaches for tissue decongestion.