Management of massive and persistent ascites and/or hydrothorax after liver transplantation.
OBJECTIVE
To describe the results of the treatment of eight liver transplantation (LT) patients subsequently developing large volumes of long-lasting ascites.


METHODS
Between August 1996 and February 2003, 405 LTs were performed in 375 patients, eight (1.97%) of whom (six men and two women of mean age of 55.4 +/- 5.2 years) subsequently developed massive (> 500 mL/d) and persistent ascites and/or hydrothorax. All patients were HCV positive. The mean age of the liver donors was 66.8 +/- 21.9 years. All LTs were performed by replacement of the recipient retrohepatic vena cava.


RESULTS
The eight patients displayed sinusoidal portal hypertension related to biopsy-proven recurrence of HCV infection. Mean wedged hepatic venous pressure was 14.9 +/- 5.1 mm Hg and mean portal vein/right atrial pressure gradient (PAPG) was 17.3 +/- 4.8 mm Hg. In two patients, the ascites appeared the day after LT; in the remaining six, ascites and/or hydrothorax appeared after 342.3 +/- 167.7 days. Seven patients with a mean PAPG of 18.4 +/- 3.9 mm Hg and a mean plasma/ascites albumin concentration gradient of 2.8 +/- 0.3 g/L were treated by means of a trans-jugular intrahepatic portosystemic shunt TIPS, and one (with a PAPG of 9 mm Hg and a plasma/ascites albumin concentration gradient of 1.38 g/L) by means of spleen arterial embolisation. After a mean follow-up of 558 +/- 147.2 days, the ascites and/or hydrothorax have resolved in five patients (62.5%), one (12.5%) has stable ascites not requiring paracentesis, and two (25%) have died of multiorgan failure.


CONCLUSIONS
These data suggest the efficacy of the aggressive treatment of massive and persistent ascites and/or hydrothorax.
Urbani
L
L
Liver Transplant Unit, University of Pisa, Ospedale Cisanello, Pisa, Italy.
Catalano
G
G
Cioni
R
R
Petruzzi
P
P
Bindi
L
L
Biancofiore
G
G
Vignali
C
C
Mosca
F
F
Filipponi
F
F
D001201:Ascites / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D006876:Hydrothorax / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies