Table 3.

Potential long-term abdominal drain (LTAD)-related complications when used in end-stage liver disease

Complication	Recommended management	Incidence observed in the REDUCe trial (LTAD vs LVP)5
Leakage	Usually self-limiting, if persists may need an extra suture. Continue ascites drainage via LTAD	Leakage/cellulitis 41% vs 11%
Cellulitis	Usually results due to leakage and is again self-limiting. If persist may need a short course of antibiotics. Very rarely LTAD needs to be removed and can be resited
Suspected peritonitis	Do a diagnostic tap for cell count and culture from peritoneum as well as taking sample from LTAD. Treat as per usual peritonitis guidelines. Decision to remove LTAD must be made on a case by case basis after discussion with patient/caregiver Routine sampling of ascitic fluid from LTAD and or routine blood tests in asymptomatic patients is not recommended.	6% vs 11%
Elevation in serum creatinine	Manage as clinically indicated	Baseline and week 12 serum creatinine (μmol/L) (median, IQR) LTAD vs LVP groups: 109 (79–141) vs 113.5 (89–134) and 104.5 (81–115.5) vs127(63–158), respectively.
LTAD blockage	Admit to hospital and discuss need for replacement	0%
LTAD displacement	Admit to hospital if necessary and discuss need for replacement	6%
Bleeding	Usually self-limiting	0% vs 5%
Unable to manage ascites symptoms despite draining 1–2 L three times a week from LTAD	Will need LVP in hospital—drain ascitic fluid via LTAD using adaptor with human albumin solution as per standard LVP protocols	13%

LVP, large volume paracentesis.