Matsuura et al developed criteria for chylous ascites that develops after liver transplant. Once identified there may several strategies for management. The authors are from Kyushu University in Fukuoa, Japan.
Patient selection: status post liver transplant
Parameters:
(1) body weight in kilograms
(2) volume of ascites fluid in mL per day
(3) appearance of ascites fluid
(4) serum triglyceride concentration in mg/dL
(5) ascites fluid triglyceride concentration in mg/dL
(6) serum cholesterol concentration in mg/dL
(7) ascites fluid cholesterol concentration in mg/dL
(8) ascites fluid cell count per µL
(9) ascites fluid differential count in percent
(10) ascites fluid culture
(11) serum albumin in g/dL
ratio of ascites fluid to serum triglyceride concentration =
= (ascites fluid triglyceride) / (serum triglyceride)
ratio of ascites fluid to serum cholesterol concentration =
= (ascites fluid cholesterol) / (serum cholesterol)
volume of ascites fluid per kilogram =
= (ascites fluid volume in mL) / (body weight in kilograms)
|
Parameter
|
Finding
|
Points
|
|
ascites fluid appearance
|
milky
|
1
|
|
|
other
|
0
|
|
triglyceride
|
fluid > 110 mg/dL
|
1
|
|
|
fluid to serum ratio > 1.0
|
1
|
|
|
other
|
0
|
|
fluid to cholesterol ratio
|
>= 1.0
|
0
|
|
|
< 1.0
|
1
|
|
fluid cell count
|
> 1,000 per µL AND negative culture
|
1
|
|
|
<= 1,000 per µL OR positive culture
|
0
|
|
fluid differential count
|
lymphocyte predominant
|
1
|
|
|
other
|
0
|
number of criteria present =
= SUM(points for all of the scored parameters)
Interpretation:
• minimum number of criteria present: 0
• maximum number of criteria present: 5
• Chylous ascites is present if the number of criteria present >= 3.
• The chylous ascites is considered refractory if the amount is > 20 mL per kg per day.
• A patient with nonrefractory chylous ascites may be started on dietary management with or without parenteral nutrition.
Indications for octreotide therapy:
(1) refractory chylous ascites
(2) nonrefractory chylous ascites that does not respond to dietary management
(3) nonrefractory chylous ascites in a child
(4) nonrefractory chylous asictes with serum albumin < 3.0 mg/dL (hypoalbuminemia).
Surgery may be considered if the patient does not respond to octreotide therapy.
