The study’s aim is to assess if palliative long term abdominal drains (which can be done at home) improve quality of life compared to hospital drainage in people with ascites due to advanced cirrhosis. 

Ascites is the most frequent cirrhosis complication, often requiring hospitalisation, and leads to the debilitating condition called refractory ascites, associated with intense pain and breathlessness. Without a liver transplant, refractory ascites has a average life expectancy of between 6-12 months. However, most patients with advanced cirrhosis are not candidates for liver transplantation, transjugular intrahepatic portosystemic shunt (TIPS) or the Automated Low Flow Ascites (ALFA) pump. The most common intervention for refractory ascites is hospitalisation every 10-14 days for palliative large volume paracentesis (LVP). This involves an abdominal drain insertion for up to six hours, removal of 5-15 litres of fluid and administration of intravenous human albumin solution.

Liver disease related deaths in England have increased by >250% since 1971. In 2018, liver disease accounted for >10% of deaths in those aged 35-49 years, greater than deaths from suicide/heart disease/breast cancer. Nationally, the COVID pandemic has resulted in a 20% increase in all cause alcohol-related deaths (mostly related to liver disease) in 2020.

Our aim is to optimise palliative management in often vulnerable individuals with refractory ascites due to advanced cirrhosis, thereby resulting in better health-related quality of life (HRQoL).