Persistent ascites post-liver transplantation is reported to be a rare event. This study aimed to determine the prevalence, risk factors, etiology and outcome of ascites post-living donor liver transplantation (LDLT).

This is a retrospective observational study on 347 recipients who underwent LDLT at our center from 2008 to 2018. We classify the ascites post-LDLT into either persistent (PA): present > four weeks post LT, or refractory (RA): new-onset ascites after the first-month post LT.

The prevalence of ascites post LDLT was 8.4% (n = 29), including PA, 4.9%, and RA, 3.45%. Idiopathic ascites (no specific cause) was the most common in the PA group, while vascular complications and graft failure were more common in the RA group. On regression analysis model, the presence of pre-LT PVT, small for size syndrome (SFSS) and vascular complications were the independent risk factors of PA (p value=0.017, 0.026, 0.011, respectively and Odds ratio (95% CI) = 4.25(1.290–13.97), 4.01(1.177–13.63) and 7.4(1.596–34.46), respectively. Pre-LT-HCV-related chronic liver disease, significant portal hypertension, donor overweight and vascular complications were the risk factors for the development of RA (p value= 0.04, 0.001, 0.031, <0.001, respectively and Odds ratio (95% CI) = 18.99 (1.1–315.14), 46.67 (4.51–483.08), 4.72 (1.15–19.31) & 67.23(6.38–708.72) respectively. Three- and five-year survival are not significantly reduced in patients who developed ascites post LDLT.

Ascites post-LDLT does not affect the 3- and 5-year survival rates. Idiopathic ascites pos-LDLT is common and has a good prognosis.