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In both conditions, the only treatment of proven value for improved survival is liver transplantation. However, because of better understanding about the pathophysiology of HRS, including the roles of portal hypertension, ascites formation and hemodynamic derangements, treatments such as transjugular intrahepatic portasystemic shunt (TIPS) and new pharmacological agents may be considered to alleviate the problem prior to transplantation. Symptomatic treatment of refractory ascites includes TIPS and repeated large volume paracentesis. Transjugular intrahepatic portasystemic shunt can improve survival while waiting for liver transplantation. Practical management guidelines for TIPS and large volume paracentesis, including the prevention and management of further complications, are considered in this review.<\/jats:p><jats:p>\u00a9 2002 Blackwell Publishing Asia Pty Ltd<\/jats:p>","DOI":"10.1046\/j.1440-1746.2002.02724.x","type":"journal-article","created":{"date-parts":[[2003,3,12]],"date-time":"2003-03-12T05:22:12Z","timestamp":1047446532000},"page":"456-461","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Management of refractory ascites and hepatorenal syndrome"],"prefix":"10.1111","volume":"17","author":[{"given":"Anuchit","family":"Chutaputti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2002,5]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510230122"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2001.22580"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(96)70068-9"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1997.v113.pm9247479"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(88)90691-9"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199109193251201"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840220120"},{"key":"e_1_2_5_9_2","first-page":"43","volume-title":"Treatment of Liver Disease","author":"Arroyo V","year":"1999"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200006083422303"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197410000-00023"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(98)70225-2"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(00)80423-7"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510270107"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510290629"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)74933-3"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(74)90637-8"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(90)90106-2"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(05)80042-X"},{"key":"e_1_2_5_20_2","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0016-5085(70)80066-X","article-title":"Effects of dopamine on renal function in patients with cirrhosis","volume":"58","author":"Barnado DE","year":"1970","journal-title":"Gastroenterology"},{"key":"e_1_2_5_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.135.7.964"},{"key":"e_1_2_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(96)80297-2"},{"key":"e_1_2_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(00)80158-0"},{"key":"e_1_2_5_24_2","first-page":"15","article-title":"Long\u2010term terlipressin administration improves renal function in cirrhotic patients with type I hepatorenal syndrome: a pilot study","volume":"64","author":"Mulkay JP","year":"2001","journal-title":"Acta Gastroenterol. 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