Recognizing sclerosing encapsulating peritonitis before liver transplantation: clinical predictors and surgical implications
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Published on: October 6, 2023
Belkacem Acidi1, Léa Bergon1, Eric Savier1
1Department of Hepatobiliary and Liver Transplant Surgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
Background:
We aimed to identify preoperative predictors of SEP and evaluate its influence on perioperative and long-term outcomes after LT.
Methods:
This retrospective single-center study included 795 consecutive adult LT recipients between 2018 and 2025. Perioperative and long-term outcomes were evaluated in a 1:1 propensity score-matched cohort of patients with and without SEP.
Results:
SEP was diagnosed intraoperatively in 24 of 273 patients with pre-transplant ascites (8.8%). Preoperative computed tomography suggested the diagnosis in 39% of cases. Compared with patients without SEP, those with SEP had a distinct pre-transplant phenotype characterized by a greater burden of ascites-related complications despite lower MELD scores. Previous spontaneous bacterial peritonitis (OR 7.24, 95% CI 2.06-25.49; p = 0.002) and pre-transplant renal dysfunction (OR 10.59, 95% CI 2.64-42.59; p = 0.001) were independently associated with SEP. In the matched cohort, SEP was associated with increased transfusion requirements, higher pulmonary and renal postoperative morbidity, and longer hospital stay. Five-year overall and graft survival were comparable between groups, whereas ascites-related event-free survival was significantly reduced in patients with SEP.
Conclusion:
SEP identifies liver transplant recipients at increased perioperative risk rather than poorer long-term prognosis. Earlier identification of SEP may also contribute to optimizing recipient selection and donor-recipient matching strategies.
