Management of Severe Ascites in Children after Liver Transplantation with the Use of Peritoneo-Venous Denver Shunt - Two Case Reports

Abstract

Introduction: Denver shunt is the peritoneo-venous shunt which is indicated for patients in whom ascites has not responded to medical management. Aim: The aim of this study is to present our experience with the use of Denver shunts in pediatric patients after liver transplantation. Material and methods: Between 2008-2012 in the Children's Memorial Health Institute there were 6 patients treated with the insertion of the Denver Shunt. In two of them the indication for the shunt was prolonged severe ascites after liver transplantation that could‘t be managed in any other way. Two boys: 17 year old and 15 years old with body mass 54 and 47 kg were transplanted due to liver failure caused by Budd-Chiari syndrome and cystic fibrosis respectively. The severe ascites has appeared just after transplantation despite of the proper graft function and normal portal and hepatic veins flow. The waste of ascitic fluid ranged between 40-120 ml/kg/24h (2200-5600ml/24h) and required albumin supplementation. The shunts were inserted on the 8 and 10 day after transplantation respectively. Results: In the first patient the shunt was removed after 7 months with the complete resolution of the ascites. He is in remission with the observation time 5 months. In the second patient the shunt is still functioning with two months follow-up. In the first one the revision of the shunt was performed due to the shunt occlusion. There was no other complications. Conclusion: It seems that the Peritoneo-venous Denver Shunt can be used effectively in selected children as the management of otherwise incurable ascites with low complication rate.