Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
University of Michigan School of Medicine, Ann Arbor, Michigan.
Hepatol Commun. 2023 May 23;7(6). doi: 10.1097/HC9.0000000000000158. eCollection 2023 Jun 1.
Ascites is common in cirrhosis but uncommon after liver transplant. We aimed to characterize the incidence, natural history, and current management strategies of post-transplant ascites.
We performed a retrospective cohort study of patients who underwent liver transplantation at 2 centers. We included patients who underwent deceased donor whole graft liver transplants between 2002 and 2019. Chart review identified patients with post-transplant ascites, requiring a paracentesis between 1 and 6-month post-transplants. Detailed chart review identified clinical and transplant characteristics, evaluation of ascites etiology, and treatments.
Of 1591 patients who successfully underwent a first-time orthotopic liver transplant for chronic liver disease, 101 (6.3%) developed post-transplant ascites. Only 62% of these patients required large volume paracentesis for ascites before transplant. 36% of patients with post-transplant ascites had early allograft dysfunction. Most patients with post-transplant ascites (73%) required a paracentesis within 2 months of transplant, but 27% had delayed ascites onset. From 2002 to 2019, ascites studies were obtained less often, and hepatic vein pressure measurement was performed more often. Diuretics were the mainstay of treatment (58%). The use of albumin infusion and splenic artery embolization to treat post-transplant ascites increased over time. Larger pre-transplant spleen size was associated with a greater number of post-transplant paracenteses (r=0.32 and p=0.003). For patients who underwent splenic intervention, paracentesis frequency was significantly reduced (1.6-0.4 paracenteses/month, p=0.0001). The majority (72%) of patients had clinical resolution of their ascites at 6-month post-transplant.
Persistent or recurrent ascites continues to be a clinical issue in the modern era of liver transplantation. Most had clinical resolution within 6 months, some requiring intervention.
腹水在肝硬化中很常见，但在肝移植后却不常见。我们旨在描述肝移植后腹水的发生率、自然史和当前的管理策略。
我们对 2 家中心进行了一项回顾性队列研究。我们纳入了在 2002 年至 2019 年间接受过尸肝整块移植的患者。病历回顾确定了在移植后 1 至 6 个月内需要进行经皮穿刺引流术的患者。详细的病历回顾确定了临床和移植特征、腹水病因的评估以及治疗方法。
在 1591 例成功接受首次原位肝移植治疗慢性肝病的患者中，有 101 例（6.3%）发生了肝移植后腹水。这些患者中只有 62%在移植前需要大量经皮穿刺引流术治疗腹水。36%的移植后腹水患者存在早期移植物功能障碍。大多数移植后腹水患者（73%）在移植后 2 个月内需要进行经皮穿刺引流术，但 27%的患者出现了延迟性腹水发作。从 2002 年到 2019 年，腹水研究的开展频率降低，而肝静脉压力测量的开展频率升高。利尿剂是主要的治疗方法（58%）。白蛋白输注和脾动脉栓塞治疗移植后腹水的应用逐渐增加。较大的术前脾脏大小与移植后经皮穿刺引流术的次数增多相关（r=0.32，p=0.003）。对于接受脾干预的患者，经皮穿刺引流术的频率显著降低（1.6-0.4 次/月，p=0.0001）。大多数（72%）患者在移植后 6 个月时腹水临床缓解。
在肝移植的现代时代，持续性或复发性腹水仍然是一个临床问题。大多数患者在 6 个月内腹水临床缓解，有些需要干预。
