Dietary interventions vs octreotide for post liver transplantation chylous ascites: A scoping review

Chylous ascites (CA), which is characterized by lymphatic leakage into the peritoneal cavity, is a rare but significant complication of liver transplantation. Although dietary and pharmacological strategies have shown effectiveness in managing CA, standardized treatment protocols have yet to be established.

To evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs) vs octreotide therapy in managing post-liver transplantation CA.

A comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotide therapy. The key parameters examined included resolution rates, treatment duration, and recurrence.

A comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospective cohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%. The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementation was used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to 100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolution rates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietary management alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotide-containing regimens than with dietary management alone (median, 7 days vs 14 days; P = 0.03).

A stepwise approach to CA management is recommended, initiating dietary interventions and escalating to octreotide when necessary. Further research through well-designed randomized controlled trials is essential to establish standardized treatment protocols for optimizing patient outcomes.