Peritoneovenous shunting for the treatment of massive ascites

To the Editor: In his editorial on the treatment of refractory ascites (Dec. 14 issue),¹ Epstein did not mention one of the most effective treatments of intractable ascites and the underlying disease that causes it — orthotopic liver transplantation. Massive ascites, as described by Stanley et al. in the same issue of the Journal,² in our experience is often an indication for liver transplantation. From September 1988 until January 1990 we performed 62 ortho-topic liver transplantations in 57 patients. Of these, 23 patients had massive ascites before or at the time of transplantation, with a maximum of 17 liters.