Abstract
Refractory ascites is a complication that almost exclusively occurs in patients with advanced portal decompensated liver cirrhosis. It is the non-response to high-dose administration of diuretics defined by inappropriate weight loss respectively the reoccurrence of ascites after paracentesis despite diuretics had been given. As prognosis is poor, these patients should be registered for liver transplantation. Standard treatment mainly includes repeated paracentesis ± diuretics. Alternative methods include transjugular intrahepatic shunt. Indications are very frequently necessary paracenteses as well as localised ascites. Attention should be paid to contraindications for shunts, such as progressed liver insufficiency or cardiac insufficiency. Possible other alternatives include administration of vasopressors, but bigger studies still remain to be done.
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