P0248 MASSIVE ASCITES AFTER PEDIATRIC LIVER TRANSPLANTATION: THE ROLE OF NUTRITION

Abstract

Introduction: Massive ascites after liver transplantation, although uncommon, may represent a serious adverse event. Small to moderate amounts of ascitic fluid are often observed in the early postoperative period but usually disappear in a few days. Nevertheless, large volumes and a long duration of ascites develop in some patients. This study conducted to determine the incidence, characteristics, and pathogenic factors of massive ascites after liver transplantation (ascites for >10 days. Methods: The charts of 61 liver transplant recipients with 67 OLT were reviewed, retrospectively. Massive ascites was arbitrarily defined as the production of ascitic fluid greater than 10 mL/kg/d, assessed by loss of ascitic fluid through drain tubes, surgical wounds, or paracentesis, that lasted longer than 10 days after the surgical procedure. Results: Postoperative ascites occurred in 13 patients (21.3%). The indications for transplantation were Autoimmune hepatitis (n=2), cryptogenic cirrhosis (n=3), metabolic liver disease (n=4), biliary atresia (n=3) and viral hepatitis (n=1). Mean ascitic fluid production was 2045mL/d (range, 625 to 3550 mL/d), and the duration of ascites was 130.1 days (range, 54 to 294 days). Angiography was performed in all patients and it revealed suprahepatic inferior vena cava stenosis (n=2), hepatic vein stenosis (n=4) and portal vein thrombosis (n=1). Massive ascites was associated with renal impairment, respiratory problems, abdominal infection and feeding difficulties in 3, 9, 6 and 11 of the patients respectively. 6 patients were treated with balloon angioplasty whose of 4 required further stent implantation because of recurrent massive ascites after angioplasty. In two patients massive ascites was attributed to large for size and small for size grafts. In the remaining 3 whose had normal angiography, ascites resolved after enteral and parenteral nutritional support. 1 patients with chylous ascites died due to sepsis. Conclusion: Massive ascites after liver transplantation is relatively uncommon but associated with increased morbidity and mortality and is predominantly related to difficulties of hepatic venous drainage. Measurement of hepatic vein and atrial pressures to detect a significant gradient and correction of possible alterations in hepatic vein outflow should be the first approach in the management of these patients.