Kosin Med J.  2021 Dec;36(2):187-192. 10.7180/kmj.2021.36.2.187.

Refractory Ascites with Intrahepatic Portal Thrombosis after Living Donor Liver Transplantation Successfully Treated by Splenic Artery Embolization and Apixaban (Case Report)

  • 1Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea


Refractory ascites is a rare complication after liver transplantation, and its incidence ranges from 5% to 7%. A 56-yearold man diagnosed with HBV-LC with massive ascites underwent living donor liver transplantation. After transplantation, more than 1000 ml/day of ascites was steadily drained until two weeks after LT. CT showed intrahepatic Rt. portal vein thrombosis and many remnant collaterals with splenomegaly. We decided to embolize the proximal splenic artery and use apixaban to reduce portal flow and resolve the intrahepatic portal thrombosis. One day after splenic artery embolization, the patient's ascites dramatically decreased. Three days later, he was discharged from the hospital. Three months later, a follow-up liver CT showed resolution of thrombosis and no ascites. Splenic artery embolization was an effective and safe procedure for portal flow modulation in portal hyertension. Apixaban was effective for partial portal vein thrombosis in a liver transplant recipient.


Apixaban; Ascites; Embolization; Liver transplantation; Portal hypertension


  • Fig. 1 Proximal splenic artery embolization with coil and plug, pre-embolization (A) post-embolization (B).

  • Fig. 2 Changes in volume of ascites after living donor liver transplantation.

  • Fig. 3 Computed tomography before splenic artery embolization (A), Computed tomography three months after splenic artery embolization (B), black circle refers to the intrahepatic portal vein.


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