2018 年 53 巻 1 号 p. 41-45
A man in his 60s with autosomal dominant polycystic kidney disease developed massive ascites 3 years after kidney transplantation. Although massive ascites was observed, the size of the spleen and liver function were within normal limits. MRI revealed that his inferior vena cava was severely compressed by an enlarged polycystic liver, and we concluded that direct compression of the inferior vena cava was the cause of his ascites. Since the ascites became resistant to medical treatment with diuretics, his renal function gradually deteriorated. To reduce the direct compression by the enlarged polycystic liver, we firstly considered partial hepatectomy or surgical fenestration of the liver cysts. But surgical revisions were thought an unsuitable option for his treatment. So he underwent the placement of a Denver peritoneo-venous shunt. Ascites was managed without any complications and impaired renal graft function was improved promptly due to appropriate circulating plasma volume.
