Ascites in hepatitis C liver transplant recipients frequently occurs in the absence of advanced fibrosis
ABSTRACT Ascites after liver transplantation is uncommon (3-7%) but causes morbidity and mortality. Although hepatitis C (HCV), pretransplant ascites, encephalopathy and cold ischemia time have been identified as predictors, neither posttransplant renal function nor the severity of recurrent HCV (inflammatory grade; fibrosis stage) has been systematically assessed. Among 173 HCV transplants (1 January 1998 to 31 December 2002), 18 patients (10%) developed posttransplant ascites. Cox proportional hazards models identified recipient female gender (hazard ratio [HR]= 12.18; p = 0.0001), cold ischemia time (HR = 1.17 per incremental hour; p = 0.021) and posttransplant creatinine (Cr) (HR = 1.56 per incremental 1.0 mg/dL; p = 0.0052) as independent predictors. Ludwig-Batts inflammation grade (HR = 1.32; p = 0.36) and fibrosis stage (HR = 1.63; p = 0.12) were not significant predictors. The 18 recipients had 19 ascites episodes; 12/19 had fibrosis stage 0, 1 or 2 (10/12 with stage 0 or 1). All 12 lacked diagnostic parenchymal or vascular histopathology. Renal function at ascites diagnosis were similar for transplants with fibrosis stage 0, 1 or 2 versus 3 or 4 (1.8 +/- 1.6 vs. 1.6 +/- 0.6 mg/dL; Cr clearance 39.6 +/- 15.6 vs. 39.3 +/- 13.4 mL/min/1.73 m(2)). In conclusion, recipient female gender, cold ischemia time and poor posttransplant renal function were independent predictors of ascites after HCV liver transplantation. Two thirds of ascites episodes, however, occurred without significant fibrosis or histopathology.
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ABSTRACT: Refractory ascites may appear in liver transplant recipients with recurrence of hepatitis C virus infection, even in the absence of advanced fibrosis. The mechanisms are unclear. The aim was to determine whether post-transplant cryoglobulinemia could be a predisposing factor for ascites in this population.Retrospective data of 82 liver transplant recipients with HCV recurrence surviving more than one year were collected. Cryoglobulinemia was systematically tested after transplantation. All patients had one year protocol biopsy with assessment of sinusoidal distension, perisinusoidal fibrosis and centrolobular necrosis. Additional biopsies were performed when needed.Fourteen out of 82 patients (17%) developed refractory ascites. When ascites appeared, fibrosis was stage F0-F1 in 36% and F2-F3 in 57%. Factors independently associated with post-transplant ascites were pre-transplant refractory ascites (p=0.001), fibrosis ≥ stage 2 at one year (p=0.002), perisinusoidal fibrosis at one year (p=0.02) and positive cryoglobulinemia (p=0.02). Patients with ascites had a significantly worse prognosis compared to those without ascites.Refractory ascites may occur in liver transplant recipients with HCV recurrence in the absence of advanced fibrosis. The finding that both positive cryoglobulinemia and perisinusoidal fibrosis at one year were significantly associated with ascites suggests that liver microangiopathy is involved in the mechanisms of HCV-related ascites.This article is protected by copyright. All rights reserved.Transplant International 09/2014; 28(2). DOI:10.1111/tri.12466 · 3.16 Impact Factor
Gastroentérologie Clinique et Biologique 08/2008; 32(8):721-726. DOI:10.1016/j.gcb.2008.05.007 · 1.14 Impact Factor
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ABSTRACT: Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to relieve the signs and symptoms of portal hypertension in patients with liver disease. The most common indications for placement are refractory ascites and variceal hemorrhage. In properly selected candidates, TIPS can serve as a bridge to liver transplantation. Expertise in the placement of TIPS following transplantation has significantly increased, allowing the procedure to become a viable option for re-transplant candidates with consequences of recurrent portal hypertension due to portal vein thrombosis (PVT), recurrent liver disease, or hepatic vein outflow obstruction (HVOO). However, TIPS in liver transplant recipients is associated with a lower clinical response and higher rate of complications than in patients with native liver disease and is therefore generally reserved for patients with a MELD < 15. The role of TIPS in non-liver transplant recipients has been well studied in large trials and translates well into clinical applicability to OLT candidates. However, the experience in OLT recipients is heterogeneous and restricted to small series. Thus the focus here is to review the current literature and discuss the proper use of TIPS in liver transplant recipients. Liver Transpl , 2013. © 2013 AASLD.Liver Transplantation 02/2014; 20(2). DOI:10.1002/lt.23775 · 3.79 Impact Factor