Persistent Ascites after Orthotopic Liver Transplantation: Analysis of Predictive Factors

Objective: Long-term persistence of ascites after orthotopic liver transplant can impact significantly on postoperative morbidity. Previous studies disclosed varied results in regard to prevalence, risk factors, ascitic fluid analysis and prognosis. The objective of the present study was to ascertain prevalence and risk factors in order to have a better understanding of this complication. Methods: All orthotopic liver transplantations performed for three consecutive years were considered for inclusion. The outcome was defined as ascites that was evident on clinical examination and/or required the use of diuretics for more than 90 days after surgery. Results: The main indications for transplant were decompensated cirrhosis and hepatocellular carcinoma. Ascites persisted in 19 (13.67%) out of 139 cases. Predictive factors were portosystemic encephalopathy, portal vein thrombosis, splenomegaly, creatinine level and volume of ascites drained during surgery. On multiple regression analysis, only the amount of ascites drained during transplantation (5.05 L × 1.58 L; p<0.008) and creatinine levels less than 12 hours before transplantation (2.39 mg/dL × 1.22 mg/dL; p=0.018) remained significantly related to ascites persistence. All biochemical analysis revealed increased serum-ascites albumin gradient. Death in the first year was similar in patients with or without ascites persistence (5.6 × 4.3%) Conclusion: This study evaluated multiple potential risk factors that could contribute to long-term persistence of ascites after liver transplantation. Loss of renal function and greater volume of ascites were significantly related to persistent ascites, which was a transudate with increased serum-ascites albumin gradient. Persistent ascites was not associated with increased mortality.