{
  "abstract": "Refractory ascites in patients with cirrhosis carries a poor prognosis and high symptom burden. Many patients have contraindications to TIPS and transplant and rely on frequent large volume paracentesis. Long-term tunnelled abdominal drains (LTADs) are increasingly used as an alternative. Preliminary data from the REDUCe study supports the safety of LTADs and their potential to reduce healthcare utilisation. This retrospective study examines LTAD use in patients with liver disease at a tertiary centre in North London.A retrospective review was performed on LTADs inserted from September 2021 to December 2024, including only patients with liver disease-related ascites. Drains placed for other causes, like malignant ascites or cardiac failure, were excluded.Out of 60 patients who received LTADs, 12 patients who had liver disease-related ascites were analysed, including one with active hepatocellular carcinoma. Most were male (66.7%), with a mean age of 65.6 years. Patients averaged 6.5 hospital presentations for ascites drainage in the six months prior to LTAD insertion. Alcohol-related and metabolic dysfunction-associated steatotic liver disease accounted for 58% of cases. 11 patients were discussed at multidisciplinary meetings (MDM) involving Palliative Care, Radiology, and Hepatology before LTAD insertion, and 81% had the LTAD placed within one month of discussion. Antibiotic prophylaxis was inconsistently used, with only 3 patients receiving it, including 2 already on secondary prophylaxis for spontaneous bacterial peritonitis. A total of 16 LTADs were inserted, with 3 patients requiring re-insertion. LTAD duration ranged from 7 to 288 days; 2 patients maintained the drain until death. Out of 10 patients discharged with LTAD, only 2 required further day unit admissions. One had two visits for leakage at the exit site, and the other had recurrent visits for paracentesis due to inadequate social support. The most common reasons for removal were tube dislodgement (3 cases) and bacterial peritonitis (2 cases). Six of eight patients died within six months of LTAD insertion. All but one patient received a Palliative Care review during admission.This retrospective review demonstrates that LTAD use in patients with liver disease has acceptable outcomes, supporting its feasibility in managing refractory ascites. The findings also highlight the poor prognosis, with 75% of patients dying within six months of insertion. Despite the severity of illness in these patients, safety events were low. Pending results from the REDUCE-2 RCT, LTAD insertion can be considered for suitable patients following MDM review, particularly for those who decline participation in the study.",
  "authors": [
    {
      "affiliations": [
        "Royal Free Hospital, UK"
      ],
      "name": "Chung Yau Brandon Nah"
    },
    {
      "affiliations": [
        "Southmead Hospital, UK"
      ],
      "name": "Claire Smith"
    },
    {
      "affiliations": [
        "Royal Free Hospital, UK"
      ],
      "name": "Emily Lynch"
    },
    {
      "affiliations": [
        "Royal Free Hospital, UK"
      ],
      "name": "Louise China"
    }
  ],
  "title": "P72 A review of long term abdominal drains in patients with liver disease-related ascites in a tertiary institution",
  "uid": "3be8fcce-0c58-5939-acd1-2ee6027270c2"
}