*Article* **Early Administration of Tolvaptan Can Improve Survival in Patients with Cirrhotic Ascites**

**Atsushi Hosui \*, Takafumi Tanimoto, Toru Okahara, Munehiro Ashida, Kohsaku Ohnishi, Yuhhei Wakahara, Yukihiro Kusumoto, Toshio Yamaguchi, Yuka Sueyoshi, Motohiro Hirao , Takuya Yamada and Naoki Hiramatsu**

> Department of Gastroenterology and Hepatology, Osaka-Rosai Hospital, 1179-3 Nagasone, Kitaku, Sakai, Osaka 591-8025, Japan; aijyousaizu@yahoo.co.jp (T.T.); t.okahara@osakah.johas.go.jp (T.O.); mashida1013@yahoo.co.jp (M.A.); k-ohnishi@osakah.johas.go.jp (K.O.); youu0805hey@yahoo.co.jp (Y.W.); yukizarulucky\_3lib@yahoo.co.jp (Y.K.); yamaguchi-to@osakah.johas.go.jp (T.Y.); sueyoshi@osakah.johas.go.jp (Y.S.); snowmotty@yahoo.co.jp (M.H.); yamada@osakah.johas.go.jp (T.Y.); hiramatsu@osakah.johas.go.jp (N.H.)

**\*** Correspondence: hosui@osakah.johas.go.jp; Tel.: +81-72-252-3561; Fax: +81-72-255-3349

**Abstract:** (1) Backgrounds and aim: Tolvaptan, a selective vasopressin type 2 receptor antagonist, was approved for ascites, and its short-term efficacy and safety have been confirmed. However, it is still unclear whether this novel drug may improve long-term survival rates in cirrhotic patients with ascites. (2) Patients and methods: A total of 206 patients who responded insufficiently to conventional diuretics and were hospitalized for refractory ascites for the first time were retrospectively enrolled in this study. Among them, the first 57 consecutive patients were treated with conventional diuretics (the conventional therapy group); the latter 149 consecutive patients were treated with tolvaptan in addition to the conventional therapy (the tolvaptan group). (3) Results: The exacerbation of renal function was significantly milder in the tolvaptan group than in the conventional therapy group. The prognostic factors for survival in the tolvaptan group were being male, having hyperbilirubinemia, having a high blood urea nitrogen (BUN), and receiving high-dose furosemide at the start of tolvaptan treatment. The one-year and three-year cumulative survival rates were 67.8 and 45.3%, respectively, in patients with low-dose furosemide (<40 mg/day) at the start of tolvaptan treatment. The prognosis was significantly better in the tolvaptan group with low-dose furosemide than in the conventional therapy group (*p* < 0.001). (4) Conclusion: Tolvaptan can improve survival in patients with cirrhotic ascites, especially when tolvaptan is started before high-dose furosemide administration.

**Keywords:** tolvaptan; cirrhotic ascites; survival rate; furosemide
