BACKGROUND: Persistent ascites is an uncommon complication after orthotopic liver transplantation (OLT). Data on etiology, treatment and outcome are limited. MATERIAL AND METHODS: Data on 691 orthotopic liver transplantations in 585 patients were reviewed retrospectively. Patients with persistent ascites (longer than 4 weeks after successful liver transplantation) were selected and for each case two controls (no ascites after 4 weeks) were assigned and matched for age, sex, etiology of liver disease and pre-transplantation Child-Pugh-score/MELD-score. RESULTS: Persistent ascites for more than 4 weeks after liver transplantation was present in 5.6% (33/585) patients and 4.8% (33/691) cases for a mean of 159 ± 174 days. The most common underlying reason was bacterial or fungal peritonitis (69.7%; 23/33). Other etiologies included renal dysfunction (6%; 2/33), obstruction of the portal vein (3%; 1/33), and obstruction of the liver vein outflow (12%; 4/33); the etiology was unclear in 9% (3/33). Liver function tests, c-reactive protein levels and parameters of renal function at 4 weeks post liver transplantation did not differ significantly between cases and controls. Patients with persistent ascites had refractory ascites before OLT significantly more often than controls. The 1-year survival rate was 92.3% for controls vs. 75.8% for cases (Kaplan Meier estimate p<0.05). Treatment (paracentesis; diuretic medical treatment; antibiotic treatment for patients with peritonitis or bacterial infection; radiologic intervention in cases of underlying vascular obstruction) resolved ascites in 72.7% (24/33 patients). Ascites due to infection was treated successfully significantly more often than all other groups (p<0.05). CONCLUSIONS: Persistent ascites after liver transplantation is rare, but is associated with reduced 1-year survival. The underlying mechanisms are diverse, abdominal bacterial infection being the most common cause. The majority of cases can be successfully treated.
BACKGROUND: Persistent ascites is an uncommon complication after orthotopic liver transplantation (OLT). Data on etiology, treatment and outcome are limited. MATERIAL AND METHODS: Data on 691 orthotopic liver transplantations in 585 patients were reviewed retrospectively. Patients with persistent ascites (longer than 4 weeks after successful liver transplantation) were selected and for each case two controls (no ascites after 4 weeks) were assigned and matched for age, sex, etiology of liver disease and pre-transplantation Child-Pugh-score/MELD-score. RESULTS: Persistent ascites for more than 4 weeks after liver transplantation was present in 5.6% (33/585) patients and 4.8% (33/691) cases for a mean of 159 ± 174 days. The most common underlying reason was bacterial or fungal peritonitis (69.7%; 23/33). Other etiologies included renal dysfunction (6%; 2/33), obstruction of the portal vein (3%; 1/33), and obstruction of the liver vein outflow (12%; 4/33); the etiology was unclear in 9% (3/33). Liver function tests, c-reactive protein levels and parameters of renal function at 4 weeks post liver transplantation did not differ significantly between cases and controls. Patients with persistent ascites had refractory ascites before OLT significantly more often than controls. The 1-year survival rate was 92.3% for controls vs. 75.8% for cases (Kaplan Meier estimate p<0.05). Treatment (paracentesis; diuretic medical treatment; antibiotic treatment for patients with peritonitis or bacterial infection; radiologic intervention in cases of underlying vascular obstruction) resolved ascites in 72.7% (24/33 patients). Ascites due to infection was treated successfully significantly more often than all other groups (p<0.05). CONCLUSIONS: Persistent ascites after liver transplantation is rare, but is associated with reduced 1-year survival. The underlying mechanisms are diverse, abdominal bacterial infection being the most common cause. The majority of cases can be successfully treated.
Authors: Mohammad Al-Zoubi; Moath Alarabiyat; Angus Hann; Homoyon Mehrzhad; Salil Karkhanis; Paolo Muiesan; Manuel Abradelo; Hermien Hartog; Keith Roberts; Darius F Mirza; John R Isaac; Bobby V M Dasari Journal: Transplant Direct Date: 2022-07-19