Lymphatic dysfunction in advanced cirrhosis: Contextual perspective and clinical implications

Table 2 Possible therapeutic strategies for treatment of lymphatic dysfunction in cirrhosis

To decrease formation of lymph
Decrease water retention	Low salt diet, diuretic therapy
Control of portal hypertension	Beta-blocker, octreotide, transjugular intrahepatic portosystemic shunt
Increase interstitial pressure	Compression therapy
To promote lymphatic drainage
Facilitate fluid movement into the lymphatic vessels	Compression therapy, limb elevation, diuretic therapy (limited role)
Increase contractility of the lymphatic vessels	Nor-adrenaline, phenylephrine, nitric oxide-inhibitors (experimental)
Facilitate lysis of interstitial protein	Benzopyrones (coumarin and flavoids)
Promote lymphangiogenesis	Prostaglandins E2 (experimental), vascular endothelial growth factor-C (experimental)
To control aggravating factors for lymphatic dysfunction
Care of lymphedema	Control of infection (aggressive use of antibiotics), avoidance of trauma, hot bath and other heat-producing treatment
Control risk factors	Control of diabetes, dyslipidemia and obesity
To decrease leakage of lymph
Decrease stimulants of intestinal lymph flow	Low fat diet, octreotide
Decrease leakage of lymph by intervention	Compression therapy, antiplasmin (tranexamic acid); radiological intervention to obliterate the site of leak
To correct underlying condition
Definitive therapy of cirrhosis	Liver transplantation