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Updated: Aug 19, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Ascites after orthotopic liver transplantation in children
Denise Herzog1, Steven Martin, Michel Lallier
1Division of Gastroenterology and Nutrition, Hopital Sainte-Justine, Universite de Montreal, Montreal, QC, Canada. denise.herzog@umontreal.ca
Insights
Postoperative ascites after liver transplantation is common (31.2%) and linked to preoperative portal hypertension. This complication, especially when isolated, may indicate hepatic origin and requires further investigation into its mechanisms.
Area of Science:
- Hepatology
- Transplantation Surgery
- Gastroenterology
Background:
- Ascites is a poorly understood postoperative complication following orthotopic liver transplantation (OLT).
- It contributes to increased morbidity and prolonged hospitalization.
- Predictive factors and etiology of postoperative ascites remain unknown.
Purpose of the Study:
- To determine the incidence of postoperative ascites after OLT.
- To identify factors predictive of ascites occurrence.
- To explore the etiology of ascites in OLT patients.
Main Methods:
- Retrospective analysis of 118 patients undergoing 138 OLTs.
- Ascites defined as >10 mL/kg/day for >10 days post-OLT.
- Patients categorized into no ascites, ascites with complications, and isolated ascites groups.
Main Results:
- Postoperative ascites occurred in 31.2% of OLTs.
- Predictive factors included biliary atresia, preoperative portal hypertension, pleural effusion, and retransplantation.
- Isolated ascites (7.9%) was associated with older age, lower platelets, and preoperative ascites, suggesting hepatic origin.
Conclusions:
- Postoperative ascites is a significant complication of OLT.
- Preoperative portal hypertension is strongly associated with its development.
- Further research into the underlying mechanisms, potentially involving donor organ perfusion dynamics, is warranted.
Abstract:
Ascites is a poorly understood postoperative complication of orthotopic liver transplantation (OLT). It is associated with additional morbidity and can prolong hospitalization considerably. The incidence, the factors predictive of occurrence and the etiology of this complication are not known. The charts of 118 patients with 138 OLT were analyzed according to the following criteria: ascites lasting longer than the first 10 postoperative days, assessed by loss of ascitic fluid through drainage tubes, surgical wounds or paracentesis, with a peak volume of > or =10 mL/kg/day. Patients were divided into three groups: Group 1, no ascites; Group 2, ascites associated with postoperative complications, including chylus ascites; and Group 3, ascites not associated with postoperative complications. Postoperative ascites occurred in 43 of 138 OLT (31.2%). Patients with biliary atresia, preoperative portal hypertension, postoperative pleural effusion or at retransplantation had ascites significantly more often. In 32 of 138 (23.2%) OLT, ascites was associated with postoperative complications, including thrombosis, abdominal infections, intestinal perforation, biliary leak, pancreatitis, and chylus ascites. In 11 of 138 (7.9%) OLT, ascites was the only postoperative complication (group 3). Group three patients were significantly older, and had lower preoperative platelet counts and preoperative ascites more often than group 1 patients. The primary liver diseases were mainly cystic fibrosis of the pancreas, congenital hepatic fibrosis, and North American Indian childhood cirrhosis. The serum-ascites albumin gradient suggested a hepatic origin of ascites. Postoperative ascites is associated with the duration and degree of preoperative portal hypertension. We speculate that the mechanism involved includes a disproportion between venous blood volume and liver uptake capacity of the donor organ.
