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Approach to persistent ascites after liver transplantation
Ana Ostojic1, Igor Petrovic2, Hrvoje Silovski2
1Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia.
World Journal of Hepatology
|October 3, 2022
Summary
Persistent ascites after liver transplantation, though uncommon, significantly increases mortality. Early diagnosis and treatment of underlying causes like vascular issues or hepatitis C are crucial for better patient outcomes.
Area of Science:
- Hepatology
- Transplantation Medicine
- Gastroenterology
Background:
- Persistent ascites (PA) affects up to 7% of liver transplant (LT) recipients, defined as ascites >4 weeks post-transplant.
- PA is linked to poorer clinical outcomes, including increased 1-year mortality.
- Causes of PA are categorized as vascular, hepatic, or extrahepatic.
Purpose of the Study:
- To outline the causes, predictors, diagnostic approaches, and management strategies for persistent ascites following liver transplantation.
- To emphasize the importance of identifying and treating specific causes of PA to improve post-transplant outcomes.
Main Methods:
- Review of vascular, hepatic (recurrent hepatitis C, acute cellular rejection), and extrahepatic causes of PA.
- Identification of predictors for PA development, including refractory ascites and hepatic encephalopathy.
- Stepwise diagnostic approach: paracentesis, Doppler ultrasound, echocardiogram, and liver biopsy if needed.
Main Results:
- Vascular causes (outflow/inflow obstruction) are often treatable.
- Recurrent hepatitis C and acute cellular rejection are key modifiable hepatic causes.
- Diagnostic tools like paracentesis and biopsy aid in identifying PA etiology.
Conclusions:
- Prompt diagnosis of treatable causes is essential for managing PA post-LT.
- Diuretics and paracentesis are initial treatments for unknown PA; TIPS and embolization for refractory cases.
- Addressing PA is critical for improving survival rates after liver transplantation.
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