To the Editor: In his editorial on the treatment of refractory ascites (Dec. 14 issue),1 Epstein did not mention one of the most effective treatments of intractable ascites and the underlying disease that causes it — orthotopic liver transplantation. Massive ascites, as described by Stanley et al. in the same issue of the Journal,2 in our experience is often an indication for liver transplantation. From September 1988 until January 1990 we performed 62 ortho-topic liver transplantations in 57 patients. Of these, 23 patients had massive ascites before or at the time of transplantation, with a maximum of 17 liters.
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