Rapid Resolution of Chylous Ascites After Liver Transplantation Using Somatostatin Analog and Total Parenteral Nutrition

Shapiro, A M James; Bain, Vincent G.; Sigalet, D.L.; Kneteman, N. M.

doi:10.1097/00007890-199605150-00023

Cited by 86 publications

(57 citation statements)

References 7 publications

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“…Propranolol was effective in 1 case reported by Gane et al, 8 and octreotide (a somatostatin analogue) was also successful in 1 case of chylous ascites after liver transplantation. 16 In the present study, ascites after liver transplantation was associated with marked renal impairment. In patients with important ascites production, fluid imbalance caused by massive ascitic fluid loss, aggravated by diuretic therapy in some occasions, could explain this renal impairment.…”

Section: Discussionsupporting

confidence: 51%

Ascites after liver transplantation

et al. 2000

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Massive ascites after liver transplantation, although uncommon, usually represents a serious adverse event. The pathogenesis of this complication has not been adequately investigated. To determine the incidence, characteristics, and pathogenic factors of massive ascites after liver transplantation (ascitic fluid G 500 mL/d for G10 days), the charts of 378 liver transplant recipients were reviewed. Massive ascites occurred in 25 patients (7%). Mean ascitic fluid production was 960 mL/d (range, 625 to 2,350 mL/d), and the duration of ascites was 77 days (range, 15 to 223 days). The ascitic fluid had a high protein content (36 ؎ 7 g/L; range, 25 to 50 g/L). When patients who did and did not develop massive ascites were compared, significant differences were found in receptor sex (men, 88% v 60%, respectively; P F .01) and surgical technique (inferior vena cava preservation with piggyback technique, 72% v 41%; P F .01). Significantly increased wedged and free hepatic venous pressures and gradients between hepatic vein and right atrial pressures were found in patients who developed ascites, suggesting a difficulty in graft blood outflow. Massive ascites was associated with renal impairment, increased incidence of abdominal infection, prolonged hospitalization, and a tendency toward reduced survival. In conclusion, massive ascites after liver transplantation is relatively uncommon but associated with increased morbidity and mortality and is predominantly related to difficulties of hepatic venous drainage. Measurement of hepatic vein and atrial pressures to detect a significant gradient and correct possible alterations in hepatic vein outflow should be the first approach in the management of these patients.

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Section: Discussionsupporting

confidence: 51%

Ascites after liver transplantation

et al. 2000

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“…[1][2][3][4][5][6][7][8][9][10] This is the first case of delayed-onset chylous ascites after liver transplant successfully managed conservatively. Chylous ascites developed about 6 months after a living-donor liver transplant.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there are only 11 articles including 10 case reports [1][2][3][4][5][6][7][8][9] (Table 1) and 1 retrospective case series study including 24 cases. 10 In most of these cases, chylous ascites is diagnosed within 1 month after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Chen

Chang²,

Lu³

et al. 2016

Exp Clin Transplant

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Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors.We report a case of chylous ascites after a livingdonor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayedonset chylous ascites after a liver transplant that was successfully treated conservatively.

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“…Improves chylous ascites by inhibiting lymph fluid excretion through specific receptors found in the normal lymphatic vessels of the intestinal wall [15,16]. However, somatostatin receptors have been found in lymphatic tissues also outside the gastrointestinal tract [16], so it is possible that there should be a direct action on lymphatic vessels.…”

Section: Discussionmentioning

confidence: 99%

Lymphorrhea in gastric cancer patients

Ali¹

2016

Integr Cancer Sci Therap

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Introduction: Lymphorrhea defined as the leakage of serous lymphatic fluid in response to lymphatic duct disturbances. It could be resulted either due to malignant neoplasms, abdominal traumas, bacterial peritonitis, pelvic irradiation, peritoneal dialysis, or abdominal tuberculosis. It could also be from iatrogenic causes such as aortic surgery, spinal surgery, and lymph node dissection for various malignancies. Chylorrhea is a form of lymphorrhea, involving digested lipid products absorbed in the small intestine. The incidence of lymphorrhea after gastrectomy is unknown, while chylorrhea with D2 or less dissection is reportedly only 0 -0.4%. In this article we would like to review the incidence, management after gastrectomy for malignant pathology and stress in the different type of lymphatic leak.

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Rapid Resolution of Chylous Ascites After Liver Transplantation Using Somatostatin Analog and Total Parenteral Nutrition

Cited by 86 publications

References 7 publications

Ascites after liver transplantation

Ascites after liver transplantation

Untitled

Lymphorrhea in gastric cancer patients

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