Arya R, Kumar R, Kumar T, Kumar S, Anand U, Priyadarshi RN, Maji T. Prevalence and risk factors of lymphatic dysfunction in cirrhosis patients with refractory ascites: An often unconsidered mechanism. World J Hepatol 2023; 15(10): 1140-1152 [PMID: 37970615 DOI: 10.4254/wjh.v15.i10.1140]
Corresponding Author of This Article
Ramesh Kumar, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rahul Arya, Ramesh Kumar, Sudhir Kumar, Tanmoy Maji, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Tarun Kumar, Department of Pathology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Utpal Anand, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Rajeev Nayan Priyadarshi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Author contributions: Arya R and Kumar R designed the manuscript, collected data, and wrote the manuscript; Kumar T contributed to the histopathological examination and data collection; Kumar S, Anand U, Priyadarshi RN, and Maji T collected data and provided critical input for the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institute research board (Reference No: AIIMS/Pat/IRC/2020/PGTh/Jan 21-22).
Informed consent statement: Informed written consent was obtained from all study participants.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Received: August 17, 2023 Peer-review started: August 17, 2023 First decision: September 5, 2023 Revised: September 14, 2023 Accepted: October 8, 2023 Article in press: October 8, 2023 Published online: October 27, 2023
ARTICLE HIGHLIGHTS
Research background
Lymphatic dysfunction occurs in patients with liver cirrhosis, although the published data on this subject is extremely limited. Given the significant role the lymphatic system plays in maintaining the balance of body fluids, it is reasonable to assume that a dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.
Research motivation
From a therapeutic standpoint, it can be extremely important to evaluate lymphatic dysfunction in cirrhosis patients with refractory ascites (RA) since it would call for using different strategies for fluid mobilization.
Research objectives
The objectives of this study were to assess the magnitude, spectrum, and clinical associations of lymphatic dysfunction in cirrhosis patients with RA using surrogate markers such as lymphedema, intestinal lymphangiectasia (IL), and chylous ascites (CA).
Research methods
This observational study was conducted as an exploratory project with a cross-sectional design and included 155 consecutive cirrhosis patients with RA. The presence of clinical signs of lymphedema, IL on duodenal biopsy, and CA were used as surrogate markers of lymphatic dysfunction.
Research results
The study found evidence of lymphatic dysfunction in nearly half of the cirrhosis patients with RA. The spectrum of dysfunction included peripheral lymphedema in 33.5%, intestinal IL in 27.0%, and CA in 1.3%. Obesity, lymphocytopenia, and hypoproteinemia were independently associated with the presence of lymphatic dysfunction in such patients.
Research conclusions
Lymphatic dysfunction is common in cirrhosis patients with RA. Hypoproteinemia and lymphocytopenia are significant indicators of its presence.
Research perspectives
Evaluation of lymphatic dysfunction in cirrhosis patients with RA can serve as a guide for future research into novel approaches for tissue decongestion.
