title: Two Unusual but Treatable Causes of Refractory Ascites After Liver Transplantation.
abstract: Refractory ascites (RA) is thought to complicate the postoperative course of 5-7% (Nishida et al. in Am J Transplant. 6: 140-149, 2006; Gotthardt et al. in Ann Transplant. 18: 378-383, 2013) of liver transplant recipients. RA after liver transplantation is often a frustrating diagnostic dilemma with few good management options unless an obvious mechanical factor is identified. Supportive therapies often fail until a treatable precipitating cause is identified and removed. We describe two patients who developed RA following liver transplantation for primary sclerosing cholangitis, and hepatitis C and alcoholic liver disease, respectively. The cause for RA was hyperkinetic portal hypertension secondary to splenomegaly in the first case and a pancreatic AVM in the 2nd case. After failure of other interventions, surgical splenectomy resulted in immediate and durable resolution of the previously intractable ascites.
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA. paulanov@umich.edu.
authors.forename: P M
authors.initials: PM
authors.lastname: Novelli
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
authors.forename: J
authors.initials: J
authors.lastname: Shields
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
authors.forename: V
authors.initials: V
authors.lastname: Krishnamurthy
authors.affiliation: Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
authors.forename: K
authors.initials: K
authors.lastname: Cho
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications*; D001201:Ascites / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities / Q000098:blood supply; D011183:Postoperative Complications / Q000209:etiology*; D013163:Splenomegaly / Q000150:complications*
keywords: Ascites/peritoneal cavity fluid; Combined treatments; Liver/hepatic; Portal vein hypertension; Transjugular intrahepatic portosystemic shunt