title: Delayed-Onset Chylous Ascites After a Living-Donor Liver Transplant: First Case Successfully Treated With Conservative Treatment?
abstract: Chylous ascites is a rare complication in liver transplant. Few cases have been reported to date. In most cases, chylous ascites is diagnosed within 1 month after surgery because of intraoperative injury of the hilar lymphatic system. Preoperative massive ascites and use of a LigaSure vessel sealing system for hilar dissection have been reported as risk factors. We report a case of chylous ascites after a living-donor liver transplant that was diagnosed after 6 months of uneventful follow-up. Sirolimus was added to cyclosporine early (2 wk after the operation) owing to poor renal function and it was found to be high (> 22 ng/mL) when the chylous ascites occurred. The patient was treated with total parenteral nutrition in combination with Sandostatin and rapid tapering of sirolimus after the failed initial conservative treatment. Residual abdominal fullness after meals and lymphedema of the legs disappeared 1 month after discontinuing sirolimus. This is the first case of delayed-onset chylous ascites after a liver transplant that was successfully treated conservatively.
authors.affiliation: From the Department of General Surgery, Dalin Tzu Chi General Hospital, Chia-I, Taiwan.
authors.forename: Jian-Han
authors.initials: JH
authors.lastname: Chen
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Lu
authors.forename: Chang-Kuo
authors.initials: CK
authors.lastname: Wei
authors.forename: Wen-Yao
authors.initials: WY
authors.lastname: Yin
mesh_terms: D002913:Chyle; D002915:Chylous Ascites / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010289:Parenteral Nutrition, Total; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D015282:Octreotide