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High mortality with refractory ascites and Hep C recurrence

Mortality rates were higher following refractory ascites development while it was ongoing, and survival was poorer among patients having bacterial peritonitis or Hep C virus recurrence, finds January's American Journal of Transplantation.

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Dr Nishidaa and colleagues retrospectively studied 1058 liver transplant recipients.

The researchers determined the incidence, etiology, timing, clinical features and treatment of refractory ascites.

The team also assessed risk factors for refractory ascites development, and predictors of refractory ascites disappearance.

In addition, the researchers evaluated predictors of survival following refractory ascites, and the impact of refractory ascites on patient survival.

The team noted that 62 patients developed refractory ascites, and its disappearance occurred in 27 of these 62 cases.

Patients having Hepatitis C virus had a significantly higher hazard rate of developing refractory ascites.

The team found no other baseline characteristic associated with refractory ascites.

Mortality rates were nearly 9 higher following refractory ascites development
American Journal of Transplantation

Cox stepwise regression analysis of the hazard rate of refractory ascites disappearance found 2 significant factors.

Using this analysis, Hepatitis C virus recurrence as the reason for developing refractory ascites was shown to result in a poorer outcome.

The researchers observed that an unknown reason for developing refractory ascites implied a favorable outcome.

Survival following refractory ascites was significantly poorer among patients having bacterial peritonitis or Hepatitis C virus recurrence.

Finally, the team noted that the mortality rate was nearly 9 higher in patients following refractory ascites development while it was ongoing.

However, the researchers found that if the refractory ascites disappeared, then the additional risk of death also disappeared.

Dr Nishidaa's team concluded, “This study illustrates the importance of developing an optimal treatment strategy.”

“Such a treatment strategy should effectively treat refractory ascites if it develops and also prevent Hepatitis C recurrence.”

Am J Transpl 2006: 6(1): 140
09 January 2006

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