P69 Long term ascites drains (LTADs) for refractory ascites – safe in clinical practice or not? A real world clinical experience update

Background/AimConcerns exist regarding increasing use of long term ascitic drains (LTADs) in patients with refractory ascites complicating cirrhosis. Current UK consensus guidelines1 recommend LTAD consideration in non-transplant candidates who are diuretic refractory/intolerant and entering a palliative phase of their illness.1 The REDUCe feasibility study2 demonstrated an increased risk of cellulitis and leakage in those with long term ascitic drains compared to standard paracentesis. Data from our own centre has revealed previously a 50% complication rate.3 Pending the ongoing REDUCe 2 trial results, the aim of this update was to evaluate our LTAD service assessing safety/efficacy of LTADs comparing to previously published data.MethodsA retrospective case note review was conducted with local QEHB audit approval. Previously published data pertained to 25 LTADs inserted January 2012 to May 2018. 62 further LTAD data was reviewed (May 2018 to December 2022).Results62 drains were done in 60 patients (70% M), 29 (47%) had ArLD, 23 (37%) NAFLD. 17 (27%) had concurrent HCC. 13 (21%) had previously documented SBP. 40 (62%) of drains were planned insertions compared to 14 (56%) in our last review. Use prophylactic antibiotics increased from 4 (14%) to 34 (53%). 57 (92%) were referred to palliative care at the time of LTAD compared to 21 (84%) in our previous review. 18 (30%) of patients were alive at 6 months compared to 13 (50%) in our previous review.Please see table 1 for a review of the complicationsWhen data amalgamated over a 10-year period (LTADs=91), the overall complication rate for LTADs was 37 (41%). 17 (19%) major and 20 (22%) minor.Abstract P69 Table 1The rate of adverse events in our cohort from 2012–2018 and 2018–2022. CTCAE, common terminology criteria for adverse events2012–201832018–2022ComplicationNumber (%)Number (%)Minor(CTCAE grade 2)Leakage3 (12)6 (10)Cellulitis3 (12)5 (8)Major(CTCAE grade 3)Drain malfunction1 (4)7 (11)Treated for SBP6 (24)6 (10)ConclusionsOur latest data demonstrates reduced rates of infections compared to our previous data and similar other complications such as leakage. Over a decade experience overall complication rate was 41% (n=37) – the majority minor. In experienced centres, insertion of LTADs remain a good palliative option however patient selection remains key and the patients need to be aware of the complication rates which will be informed by REDUCe2.ReferencesMacken L, Corrigan M, Prentice W on behalf of the B