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Refractory Ascites After Liver Transplantation: An Analysis of 1058 Liver Transplant Patients at a Single Center
Author(s) -
Nishida S.,
Gaynor J. J.,
Nakamura N.,
Butt F.,
Illanes H. G.,
Kadono J.,
Neff G. W.,
Levi D. M.,
Moon J. I.,
Selvaggi G.,
Kato T.,
Ruiz P.,
Tzakis A. G.,
Madariaga J. R.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01161.x
Subject(s) - medicine , ascites , hazard ratio , gastroenterology , liver transplantation , proportional hazards model , incidence (geometry) , refractory (planetary science) , single center , retrospective cohort study , spontaneous bacterial peritonitis , etiology , hepatitis c virus , transplantation , confidence interval , immunology , virus , physics , astrobiology , optics
A retrospective study of 1058 liver transplant recipients was performed to determine: (i) the incidence, etiology, timing, clinical features and treatment of refractory ascites (RA), (ii) risk factors for RA development, (iii) predictors of RA disappearance, (iv) predictors of survival following RA and (v) the impact of RA on patient survival. Sixty‐two patients (5.9%) developed RA and its disappearance occurred in 27/62 cases. Patients having hepatitis C virus (HCV) had a significantly higher hazard rate of developing RA (p < 0.00001). No other baseline characteristic was associated with RA. Cox stepwise regression analysis of the hazard rate of RA disappearance found two significant factors: HCV recurrence as the reason for developing RA implied a poorer outcome (p = 0.006), whereas an unknown reason implied a favorable outcome (p = 0.02). In addition, survival following RA was significantly poorer among patients having bacterial peritonitis or HCV recurrence. Finally, the mortality rate was significantly (nearly 8.6 times) higher in patients following RA development while it was ongoing (p < 0.00001); however, if the RA disappeared, then the additional risk of death also disappeared. This study illustrates the importance of developing an optimal treatment strategy to (i) effectively treat RA if it develops and (ii) prevent hepatitis C recurrence.