Chylous ascites after liver transplantation incidence and risk factors

Abstract

In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after livertransplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One-hundred fifteenof these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data.Chylous ascites developed after LT (mean 6 SD ¼ 8.0 6 3.2 days, range ¼ 5-17 days) in 24 of the 516 patients includedin this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developingchylous ascites: age, sex, body mass index, graft-to-recipient weight ratio, Model for End-Stage Liver Disease score, venacava cross-clamping time, total operation time, Child-Pugh classification, sodium level, portal vein thrombosis or ascitesbefore transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system(LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P ¼ 0.04), the presenceof ascites before transplantation (P ¼ 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors fordeveloping chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant asci-tes [P ¼ 0.04, hazard ratio (HR) ¼ 2.8, 95% confidence interval (CI) ¼ 1.1-13.5] and the use of LVSS for perihepatic dis-section (P ¼ 0.01, HR ¼ 5.4, 95% CI ¼ 1.5-34.4) were independent risk factors. In conclusion, the presence ofpreoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylousascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Neverthe-less, our results should be supported by new prospective trials. Liv er Transpl 18:1046-1052, 2012.VC2012 AASLD.