Ascites After Liver Transplantation

Jenkins, Michelle; Satoskar, Rohit

doi:10.1002/cld.1050

Cited by 4 publications

(14 citation statements)

References 19 publications

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“…As proposed earlier, the next step in the evaluation should be an ultrasound of the abdomen with included Doppler to assess for mechanical obstructions (vascular pathology). During the examination, it is recommended to measure liver graft and spleen size and calculate spleen to graft volume ratio as it might influence the treatment modalities, depending on the final diagnosis[ 8 , 17 , 28 ]. Angiography and invasive hemodynamic evaluation should be performed as a confirmation method for suspected mechanical obstruction[ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…A serum to ascites albumin gradient should be determined. However, its use for the assessment of portal hypertension is limited in post-transplantation settings[ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…The workup of patients with PA after LT should be directed to exclude extrahepatic causes of ascites, such as heart failure, chronic renal disease, malignancy, or infection[ 17 ]. Finally, the etiology of PA after LT can remain unknown.…”

Section: Etiologymentioning

confidence: 99%

“…This theory is supported by the results of the study by Gadano et al [ 16 ], where patients with severe acute rejection had a higher hepatic venous pressure gradient than those with moderate or mild rejection. Following the treatment of acute cellular rejection, ascites usually resolves[ 17 ].…”

Section: Etiologymentioning

confidence: 99%

“…Several studies have shown that prolonged CI significantly influences PA development after LT[ 5 , 6 , 18 ]. Considering that CI time plays a significant part in the ischemic injury of the liver that primarily damages sinusoidal endothelium and results in increased hepatic resistance, PA can be expected if CI is prolonged[ 17 , 18 ]. A retrospective study involving 439 patients after living donor liver transplantation found that recipient spleen to graft volume ratio > 1.3, left lobe graft and graft recipient weight ratio < 0.8 were risk factors for persistent massive ascites after LT[ 22 ].…”

Section: Etiologymentioning

confidence: 99%

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Approach to persistent ascites after liver transplantation

Ostojić¹,

Petrović²,

Silovski³

et al. 2022

World J Hepatol

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Persistent ascites (PA) after liver transplantation (LT), commonly defined as ascites lasting more than 4 wk after LT, can be expected in up to 7% of patients. Despite being relatively rare, it is associated with worse clinical outcomes, including higher 1-year mortality. The cause of PA can be divided into vascular, hepatic, or extrahepatic. Vascular causes of PA include hepatic outflow and inflow obstructions, which are usually successfully treated. Regarding modifiable hepatic causes, recurrent hepatitis C and acute cellular rejection are the leading ones. Considering predictors for PA, the presence of ascites, refractory ascites, hepato-renal syndrome type 1, spontaneous bacterial peritonitis, hepatic encephalopathy, and prolonged ischemic time significantly influence the development of PA after LT. The initial approach to patients with PA should be to diagnose the treatable cause of PA. The stepwise approach in evaluating PA includes diagnostic paracentesis, ultrasound with Doppler, and an echocardiogram when a cardiac cause is suspected. Finally, a percutaneous or transjugular liver biopsy should be performed in cases where the diagnosis is unclear. PA of unknown cause should be treated with diuretics and paracentesis, while transjugular intrahepatic portosystemic shunt and splenic artery embolization are treatment methods in patients with refractory ascites after LT.

show abstract

Section: Discussionmentioning

confidence: 99%

“…A serum to ascites albumin gradient should be determined. However, its use for the assessment of portal hypertension is limited in post-transplantation settings[ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

See 3 more Smart Citations

Approach to persistent ascites after liver transplantation

Ostojić¹,

Petrović²,

Silovski³

et al. 2022

World J Hepatol

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Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review

Pagano,

Toniutto,

Burra

et al. 2024

Digestive and Liver Disease

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Tuberculosis is a Common Cause of Post-Liver Transplant Ascites: An Observational Study

R.,

Kulkarni,

Sharma

et al. 2022

Journal of Gastrointestinal Infections

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Background Ascites is expected to resolve within 2 to 4 weeks following orthotopic liver transplantation. New-onset ascites after transplant is associated increased morbidity and affects quality of life. The risk of opportunistic infections is high in transplant recipients due to immunosuppressive drugs. Objective The objective was to assess the incidence of new-onset ascites in the transplant recipients and describe the cause and course of the same. Methods We retrospectively collected data of all the patients who underwent liver transplantation at our center from April 1, 2020 to April 1, 2021. The details of patients developing ascites post-liver transplantation were retrieved. The patients were followed up for 1 year after transplant. Results A total of 95 patients underwent living donor liver transplantation at our center. The incidence of new-onset ascites was 8.42% (8/95). Six out eight patients were diagnosed with tubercular ascites of whom one had disseminated tuberculosis. None of the patients had concomitant pulmonary tuberculosis. Ascites secondary to hypoalbuminemia was reported in two patients. Immunoglobulin A nephropathy and tacrolimus therapy were the underlying causes of proteinuria. Conclusion Tuberculosis was the leading cause of ascites in post-transplant period in our study. Tuberculosis should be considered as a differential diagnosis while evaluating these patients especially in the Asia-Pacific region. Being a potentially curable cause, timely diagnosis and treatment significantly improves graft survival.

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Ascites After Liver Transplantation

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-4-reading-jenkins a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/17-4-interview-jenkins the interview with the author

Cited by 4 publications

References 19 publications

Approach to persistent ascites after liver transplantation

Approach to persistent ascites after liver transplantation

Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review

Tuberculosis is a Common Cause of Post-Liver Transplant Ascites: An Observational Study

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