title: Impact of preoperative uncontrollable hepatic hydrothorax and massive ascites in adult liver transplantation.
abstract: OBJECTIVE
  Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course.
  
  
  METHODS
  We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010.
  
  
  RESULTS
  Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7%, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9%; 3 years: 58.9 vs. 77.7%; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis.
  
  
  CONCLUSIONS
  Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.
authors: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan, kosukee@kuhp.kyoto-u.ac.jp.
authors: Kosuke
authors: K
authors: Endo
authors: Taku
authors: T
authors: Iida
authors: Shintaro
authors: S
authors: Yagi
authors: Atsushi
authors: A
authors: Yoshizawa
authors: Yasuhiro
authors: Y
authors: Fujimoto
authors: Kohei
authors: K
authors: Ogawa
authors: Yasuhiro
authors: Y
authors: Ogura
authors: Akira
authors: A
authors: Mori
authors: Toshimi
authors: T
authors: Kaido
authors: Shinji
authors: S
authors: Uemoto
mesh_terms: D000328:Adult; D001201:Ascites / Q000628:therapy*; D016470:Bacteremia / Q000453:epidemiology; D004322:Drainage; D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000628:therapy*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D057234:Preoperative Period; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate