Ascites after liver transplantation

Massive ascites after liver transplantation, although uncommon, usually rep resents a serious adverse event. The pathogenesis of this complication has not been adequately investigated. To determine the incidence, characteristi cs, and pathogenic factors of massive ascites after liver transplantation ( ascitic fluid > 500 mL/d for >10 days), the charts of 378 liver transplant recipients were reviewed. Massive ascites occurred in 25 patients (7%). Mea n 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 patie nts who did and did not develop massive ascites were compared, significant differences were found in receptor sex (men, 88% v 60%, respectively; P <.0 1) and surgical technique (inferior vena cava preservation with piggyback t echnique, 72% v 41%; P <.01). Significantly increased wedged and free hepat ic venous pressures and gradients between hepatic vein and right atria pres sures were found in patients who developed ascites, suggesting a difficulty in graft blood outflow. Massive ascites was associated with renal impairme nt, increased incidence of abdominal infection, prolonged hospitalization, and a tendency toward reduced survival. In conclusion, massive ascites afte r liver transplantation is relatively uncommon but associated with increase d morbidity and mortality and is predominantly related to difficulties of h epatic 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 patien ts. Copyright (C) 2000 by the American Association for the Study of Liver D iseases.