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Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
Published on: December 30, 2025
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Ascites and Hepatorenal Syndrome
Danielle Adebayo1, Shuet Fong Neong1, Florence Wong1
1Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Room 222, 9th floor, Eaton Wing, Toronto, Ontario M5G2C4, Canada.
Clinics in Liver Disease
|September 30, 2019
Summary
Cirrhosis patients often develop ascites, managed with diuretics or paracentesis. Refractory ascites (RA) can lead to severe kidney issues like hepatorenal syndrome (HRS), with liver or combined liver-kidney transplants offering definitive treatment.
Area of Science:
- Hepatology and Nephrology
- Gastroenterology
- Internal Medicine
Background:
- Ascites is a common complication of cirrhosis, affecting up to 70% of patients.
- Management strategies vary from conservative (sodium restriction, diuretics) to invasive (paracentesis, transjugular intrahepatic portosystemic shunt).
- Refractory ascites (RA) presents significant challenges, particularly the high incidence of renal impairment.
Purpose of the Study:
- To outline the clinical management of ascites in cirrhosis.
- To detail treatment options for refractory ascites.
- To discuss the renal complications of refractory ascites, including hepatorenal syndrome (HRS).
Main Methods:
- Review of current clinical practices for ascites management in cirrhosis.
- Analysis of treatment algorithms for refractory ascites.
- Evaluation of renal impairment and hepatorenal syndrome in RA patients.
- Assessment of transplant eligibility criteria for HRS and combined organ transplantation.
Main Results:
- Uncomplicated ascites managed with sodium restriction and diuretics.
- Refractory ascites managed with large-volume paracentesis or TIPS.
- Renal impairment affects up to 50% of RA patients, with Type 1 HRS being the most severe.
- Liver transplant is definitive for eligible HRS patients; combined liver-kidney transplant considered for those on dialysis or with CKD.
Conclusions:
- Effective management of ascites is crucial in cirrhosis care.
- Renal complications, especially HRS, significantly impact prognosis in RA.
- Transplant options, including combined liver-kidney, are vital for end-stage disease management.
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