ASCITE APRES TRANSPLANTATION HEPATIQUE CHEZ L'ENFANT

The objective of this study, based on a series of 148 transplants performed in 131 children, was to evaluate the frequency, complications and predisposing factors of ascites occurring after liver transplantation (LT). The diagnosis of post-LT ascites was defined as a drainage rate greater than 25 ml/kg/day (or > 500 ml/day) persisting for at least 72 hours after removal of the drains. Among the 123 transplants analysed, 31 (25.2%) were complicated by ascites (group I). Groupe II consisted of 92 LT without ascites. This ascites was predominantly lymphocytic (669 ± 1104/mm³), rich in proteins (32 ± 13 g/l), with a low triglyceride concentration. The mean duration of ascites was 25 ± 19 days. Complications of ascites included: infection of ascitic liquid (35%), respiratory complications (65%), parietal complications (50%), consumption coagulopathy (35%), functional renal failure (Creat > 130 μmol/l, 35%). There were 9 deaths (29%) in group I versus 8 in group II (p < 0.02). The predictive factors, pre-LT, of postoperative ascites included: serum bilirubin > 300 μmol/l (p < 0.02) ; PT < 30% (p < 0.05); and serum albumin < 30 g/l (p < 0.05). Intraoperative factors favouring the development of ascites were end-to-side cavo-caval implantation of the graft when it was reduced (p < 0.02) and a volume of transfused blood after unclamping greater than 60 ml/kg (p < 0.01). Post-LT, a serum bilirubin greater than 150 μmol/l, ASAT greater than 2500 IU/I before D3, and the appearance of acute rejection before D 10 were significantly associated with the development of ascites (p < 0.001, p < 0.001, p < 0.05, respectively). In conclusion, postoperative ascites increases the morbidity and mortality of LT in children. It is a lymphatic type of ascites, favoured by the presence of preoperative hepatocellular failure, suprahepatic block or graft disorders (primary dysfunction, acute rejection).