Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center

Abstract

A retrospective study of 1058 liver transplant recipients was performed to determine: (i) the incidence, etiology, timing, clinical features and treatment of refractory ascites (RA), (ii) risk factors for RA development, (iii) predictors of RA disappearance, (iv) predictors of survival following RA and (v) the impact of RA on patient survival. Sixty-two patients (5.9%) developed RA and its disappearance occurred in 27/62 cases. Patients having hepatitis C virus (HCV) had a significantly higher hazard rate of developing RA (p < 0.00001). No other baseline characteristic was associated with RA. Cox stepwise regression analysis of the hazard rate of RA disappearance found two significant factors: HCV recurrence as the reason for developing RA implied a poorer outcome (p = 0.006), whereas an unknown reason implied a favorable outcome (p = 0.02). In addition, survival following RA was significantly poorer among patients having bacterial peritonitis or HCV recurrence. Finally, the mortality rate was significantly (nearly 8.6 times) higher in patients following RA development while it was ongoing (p < 0.00001); however, if the RA disappeared, then the additional risk of death also disappeared. This study illustrates the importance of developing an optimal treatment strategy to (i) effectively treat RA if it develops and (ii) prevent hepatitis C recurrence.

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“…Endovascular treatment options also play a limited role in nonvascular causes, such as recurrent infection or rejection needing medical treatment or liver transplant. 1,4,5 …”

“…Either a percutaneous ultrasonography-guided biopsy or a transjugular liver biopsy should be used, with the latter reserved for patients with severe coagulopathy, large amount of ascitic fluid, or if pressures in the hepatic vein need to be measured. 1,4 Figure 1 shows a diagnostic algorithm for evaluation of RA after liver transplant.…”

“…Recurrence of hepatitis C virus is directly associated with increased risk of RA after liver transplant and is also associated with a poor prognosis. 1 …”

“…1 In addition to a poor prognosis, with 1-year transplant-free survival in patients with advanced-stage cirrhosis of 20% to 50%, 2 patients with RA usually have additional complications such as spontaneous bacterial peritonitis, hepatorenal syndrome, and pleural effusion. 3 However, this condition has received little attention in the transplant literature.…”

Outcomes of Incisional Hernia Repair Following Liver Transplantation

“…7 Karaciğer nakli gerektiren kronik karaciğer hastaları; protein-enerji malnutrisyonunun yol aç-tığı kaşeksi ve kas kitle kaybı, hiperbilirubinemi, portal hipertansiyon sonrası oluşan asit ve immün-supresif ilaçların [kortikosteroidler, mikofenolat mofetil (MMF), mikofenolik asit, sirolimus] kullanımı gibi, İH oluşumuna katkıda bulunan ek risk faktörlerine sahiptirler. [14][15][16][17][18][19][20][21] Ayrıca, KN için kullanılan bilateral subkostal, "Mercedes", "hockey stick" gibi büyük karın insizyonları da İH gelişim riskini arttırabilir. 7 Bu çalışmada KN yapılan sonrası İH ortaya çıkan hastalar ve bunların onarım sonuçları sunulmaktadır.…”