Ascites development is associated with worse outcome in patients after kidney transplantation

Abstract

Background We provide detailed analysis and outcomes in patients post‐kidney transplant (KT) developing ascites, which has never been categorically reported. Methods Ascites was identified by ICD9/10 codes and detailed chart review in patients post‐KT from 01/2004‐06/2019. The incidence of patient death and graft loss were determined per 100‐person‐years, and the incidence rate ratio was obtained. Results Of 3329 patients receiving KT, 83 (2.5%) patients had new‐onset ascites, of whom 58% were male, 21% blacks, and 29% whites. Seventy‐five percentage were on hemodialysis. Patients were maintained primarily on tacrolimus and mycophenolate for immunosuppression. Only 14% of patients with ascites had the appropriate diagnostic workup. There was a trend toward an increased mortality in patients with ascites (incidence rate ratio, IRR [95% CI]: 1.8 [0.92, 3.19], p = .06), and a significantly higher incidence of graft loss (IRR: 5.62 [3.97, 7.76], p < .001), compared with non‐ascites patients. When classified by ascites severity, determined by imaging, moderate/severe ascites patients had the worst clinical outcomes, with a mortality of 32% and graft failure in 57%, compared with 9% and 10%, respectively, in those without ascites. Conclusion In this large cohort employing stepwise analysis of ascites post‐KT, worse outcomes were noted, dictating the need for optimized management to improve clinical outcomes.