Approach to persistent ascites after liver transplantation

Scientific paper - Review paper

• Author: Ana Ostojić
• Author: Igor Petrović
• Author: Hrvoje Silovski
• Author: Iva Košuta
• Author: Maja Sremac
• Author: Anna Mrzljak
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (english)

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.

• Keywords (english): Acute cellular rejection; Hepatic graft inflow obstructions; Hepatic graft outflow obstructions; Liver transplantation; Liver transplantation complications, Ascites
• Language: english
• Publication type: Scientific paper - Review paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: World Journal of Hepatology
• Numbering: vol. 14, no. 9, pp. 1739-1746
• p-ISSN: 1948-5182
• DOI: https://doi.org/10.4254/wjh.v14.i9.1739
• URN:NBN: urn:nbn:hr:105:408151
• Publication: 2022-09-27
• Document URL: https://www.wjgnet.com/1948-5182/full/v14/i9/1739.htm
• Type of resource: Text
• Access conditions: Open access
• Created on: 2023-08-25 08:07:34