Refractory ascites with liver fibrosis developed in late phase allogeneic hematopoietic stem cell transplantation: report of three patients.

We report cases of three patients of refractory ascites without other fluid retention that occurred around five months after allogeneic hematopoietic stem cell transplantation (allo-HSCT). All three patients expired and post-mortem examinations revealed unexpected liver fibrosis lacking histological evidences of graft-uersus-host-disease (GVHD). The three patients showed normal hepatic function and size before transplantation. During their clini-cal courses, serum biochemistry test showed no elevation of hepatic enzymes and bilirubin; however, imaging studies demonstrated hepat-ic atrophy at the onset of ascites. One of the liver specimens showed bile obstruction, which could be seen in hepatic damage by GVHD. Although ascites resulting from veno-occlusive disease in early phase allo-HSCT is well documented, ascites associated with hepatic fibrosis in late phase allo-HCST has not been reported. Further clinico-pathological studies on similar patients should be required to ascertain refractory ascites associated with liver fibrosis after allo-HSCT. [ABSTRACT FROM AUTHOR]