The patient with refractory ascites.

Refractory ascites indicates advanced chronic liver disease and represents a therapeutic challenge. It may be triggered by spontaneous bacterial peritonitis and denotes poor prognosis. While liver transplantation is the ultimate treatment, for the relief of ascites therapeutic paracentesis with iv-administration of albumin and/or transjugular intrahepatic portosystemic shunt (TIPS) are well established. With rapid deterioration of renal function patients can develop hepatorenal syndrome. There is increasing evidence that these patients can be bridged to transplantation with vasopressin analogs (terlipressin) and albumin.