Abstract
BACKGROUND: Chylous ascites (CA), which is characterized by lymphatic leakage into the peritoneal cavity, is a rare but significant complication of liver transplantation. Although dietary and pharmacological strategies have shown effectiveness in managing CA, standardized treatment protocols have yet to be established. AIM: To evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs) vs octreotide therapy in managing post-liver transplantation CA. METHODS: A comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotide therapy. The key parameters examined included resolution rates, treatment duration, and recurrence. RESULTS: A comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospective cohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%. The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementation was used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to 100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolution rates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietary management alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotide-containing regimens than with dietary management alone (median, 7 days vs 14 days; P = 0.03). CONCLUSION: A stepwise approach to CA management is recommended, initiating dietary interventions and escalating to octreotide when necessary. Further research through well-designed randomized controlled trials is essential to establish standardized treatment protocols for optimizing patient outcomes.