Ascites after orthotopic liver transplantation in children Ascites is a frequent but poorly understood complication that occurs during the early post- operative period of OLT. It usually disappears spontaneously after a few days, and its produc- tion is believed to depend on the presence and degree of the hyperdynamic circulation, sodium levels, malnutrition, portopulmonary hyperten- sion or cardiac dysfunction (1, 2). Nevertheless, ascites production is associated with postopera- tive complications, such as thrombosis or steno- sis at vascular anastomoses (3, 4) or abdominal infections. Moreover, some patients develop ascites of large volume and long duration for no apparent reason. The latter type of ascites prolongs hospitalization, increases the risk of complications, such as cardiac insufficiency, renal dysfunction, thrombotic incidents, and abdom- inal infections (5). Ascites has been shown to occur in 7% of adult patients after OLT (6). The current study investigates the incidence and characteristics of ascites of long duration after OLT in pediatric patients and describes Herzog D, Martin S, Lallier M, Alvarez F. Ascites after orthotopic liver transplantation in children. Pediatr Transplantation 2005: 9: 74–79. Ó 2005 Blackwell Munksgaard Abstract: Ascites is a poorly understood postoperative complication of orthotopic liver transplantation (OLT). It is associated with additional morbidity and can prolong hospitalization considerably. The incidence, the factors predictive of occurrence and the etiology of this complication are not known. The charts of 118 patients with 138 OLT were analyzed according to the following criteria: ascites lasting longer than the first 10 postoperative days, assessed by loss of ascitic fluid through drainage tubes, surgical wounds or paracentesis, with a peak volume of ‡10 mL/kg/day. Patients were divided into three groups: Group 1, no ascites; Group 2, ascites associated with postoperative complications, including chylus ascites; and Group 3, ascites not associated with postoperative complications. Postoperative ascites occurred in 43 of 138 OLT (31.2%). Patients with biliary atresia, preoperative portal hypertension, postoperative pleural effusion or at retransplantation had ascites significantly more often. In 32 of 138 (23.2%) OLT, ascites was associated with postoperative complications, including thrombosis, abdominal infections, intestinal perforation, biliary leak, pancreatitis, and chylus ascites. In 11 of 138 (7.9%) OLT, ascites was the only postoperative complication (group 3). Group three patients were significantly older, and had lower preoperative platelet counts and preoperative ascites more often than group 1 patients. The primary liver diseases were mainly cystic fibrosis of the pancreas, congenital hepatic fibrosis, and North American Indian childhood cirrhosis. The serum-ascites albumin gradient suggested a hepatic origin of ascites. Postoperative ascites is associated with the duration and degree of preoperative portal hypertension. We speculate that the mechanism involved includes a disproportion between venous blood volume and liver uptake capacity of the donor organ. Denise Herzog 1 , Steven Martin 1 , Michel Lallier 2 and Fernando Alvarez 3 1 Division of Gastroenterology and Nutrition, Departments of 2 Surgery, and 3 Pediatrics, Hôpital Sainte-Justine, UniversitØ de MontrØal, Montreal, QC, Canada Key words: pediatric – portal hypertension – congenital liver disease – complications – albumin Denise Herzog MD, Division of Gastroenterology and Nutrition, Hôpital Sainte-Justine, 3175 Côte Sainte- Catherine, MontrØal, QC, Canada H3T 1C5 Tel.: (514) 345-4626 Fax: (514) 345-4999 E-mail: denise.herzog@umontreal.ca Accepted for publication 16 June 2004 Abbreviations: AIH, autoimmune hepatitis; ASAR, albu- min serum-ascites ratio; CF, cystic fibrosis of the pancreas; CHF, congenital hepatic fibrosis; CI, confidence interval; CMV, cytomegalovirus; NAIC, North American Indian childhood cirrhosis; OLT, orthotopic liver transplantation; OR, odds ratio; PFIC, progressive familial intrahepatic cholestasis. SAAG, serum-ascites albumin gradient. Pediatr Transplantation 2005: 9: 74–79. DOI: 10.1111/j.1399-3046.2005.00259.x Printed in Singapore. All rights reserved Copyright Ó 2005 Blackwell Munksgaard Pediatric Transplantation 74