The incidence and natural history of ascites after liver transplantation

Abstract

Background: Ascites is common in cirrhosis but uncommon after liver transplant. We aimed to characterize the incidence, natural history, and current management strategies of post-transplant ascites. Methods: We performed a retrospective cohort study of patients who underwent liver transplantation at 2 centers. We included patients who underwent deceased donor whole graft liver transplants between 2002 and 2019. Chart review identified patients with post-transplant ascites, requiring a paracentesis between 1 and 6-month post-transplants. Detailed chart review identified clinical and transplant characteristics, evaluation of ascites etiology, and treatments. Results: Of 1591 patients who successfully underwent a first-time orthotopic liver transplant for chronic liver disease, 101 (6.3%) developed post-transplant ascites. Only 62% of these patients required large volume paracentesis for ascites before transplant. 36% of patients with post-transplant ascites had early allograft dysfunction. Most patients with post-transplant ascites (73%) required a paracentesis within 2 months of transplant, but 27% had delayed ascites onset. From 2002 to 2019, ascites studies were obtained less often, and hepatic vein pressure measurement was performed more often. Diuretics were the mainstay of treatment (58%). The use of albumin infusion and splenic artery embolization to treat post-transplant ascites increased over time. Larger pre-transplant spleen size was associated with a greater number of post-transplant paracenteses (r=0.32 and p=0.003). For patients who underwent splenic intervention, paracentesis frequency was significantly reduced (1.6–0.4 paracenteses/month, p=0.0001). The majority (72%) of patients had clinical resolution of their ascites at 6-month post-transplant. Conclusions: Persistent or recurrent ascites continues to be a clinical issue in the modern era of liver transplantation. Most had clinical resolution within 6 months, some requiring intervention.

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

“…Median range of hospital stay was 11-28 days and blood loss ranged from 250-3600 mL. LT is a major procedure with many major or minor complications [76][77][78][79][80][81][82][83]. Some of the most common post-operative LT complications that require surgical intervention include biliary complications (biliary peritonitis, biliary leakage, biliary stricture), internal hernias, ascites, abscesses and rejection-related complications [84][85][86][87][88].…”

An integrated proteomics and metabolomics approach to assess graft quality and predict early allograft dysfunction after liver transplantation: a retrospective cohort study

“…Several studies have demonstrated that EAD independently increases the risk of acute kidney injury and chronic kidney failure in LT recipients 4 , 6 . EAD has also been reported to correlate with post-transplant ascites, sepsis, and multiple organ failure 7 , 8 . Third, EAD prolongs the duration of mechanical ventilation, intensive care unit (ICU) stay, and hospitalization 5 , 6 .…”