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World J Hepatol. Sep 27, 2022; 14(9): 1739-1746
Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1739
Approach to persistent ascites after liver transplantation
Ana Ostojic, Igor Petrovic, Hrvoje Silovski, Iva Kosuta, Maja Sremac, Anna Mrzljak
Ana Ostojic, Maja Sremac, Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
Igor Petrovic, Hrvoje Silovski, Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, Zagreb 10000, Croatia
Iva Kosuta, Department of Intensive Care Medicine, University Hospital Center Zagreb, Zagreb 10000, Croatia
Author contributions: Ostojic A contributed to the literature review, analysis, and interpretation of the data, drafting of the initial manuscript, and final approval of the manuscript; Petrovic I, Silovski H, Kosuta I, and Sremac M contributed to the analysis and interpretation of the data, and final approval of the manuscript; Mrzljak A contributed to the conception and design of the manuscript, critical revised the initial manuscript, and approved the final manuscript.
Supported by the Croatian Science Foundation, Emerging and Neglected Hepatotropic Viruses after Solid Organ and Hematopoietic Stem Cell Transplantation (to Mrzljak A), No. IP-2020-02-7407.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Mrzljak, FEBG, PhD, Associate Professor, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Kišpatićeva ulica 12, Zagreb 10000, Croatia. anna.mrzljak@gmail.com
Received: July 6, 2022
Peer-review started: July 6, 2022
First decision: July 28, 2022
Revised: August 8, 2022
Accepted: September 2, 2022
Article in press: September 2, 2022
Published online: September 27, 2022
Processing time: 78 Days and 8.9 Hours
Core Tip

Core Tip: Despite being relatively rare, persistent ascites after liver transplantation is associated with worse clinical outcomes. Therefore, it is of primary concern to promptly diagnose and treat modifiable causes of ascites. Early evaluation should include ultrasound with Doppler and diagnostic paracentesis. Common treatable causes include hepatic inflow and outflow obstruction, recurrent hepatitis C infection, and acute cellular rejection. Ascites of unknown cause should be treated with diuretics and paracentesis, while transjugular intrahepatic portosystemic shunt and splenic artery embolization can be used in patients with refractory ascites. The latter option represents a novel treatment modality with promising results.