Abstract: Objective To analyze the risk factors relate to massive ascites after the living donor liver transplantation (LDLT) in adult and the impact of massive ascites on patient survival. Methods Clinical data of 105 adult patients undergone LDLT from 2005 to 2011 in West China Hospital were retrospectively analyzed. The risk factors for massive ascites were firstly determined with univariate analysis, then with two logistic regression analysis if P<0.1 by univariate analysis. Kaplan-Meier survival curve was used to investigate the association between massive ascites and patient survival. Results The average amount of ascites within seven days postoperatively in 105 LDLT cases was 5 362 mL (766 mL per day), and massive ascites developed in 27 patients (25.7%). The variables, including receptor age, liver disease, preoperative MELD score, Child-Pugh score, preoperative ascites, preoperative INR, preoperative total bilirubin, preoperative serum albumin, operative time, postoperative SOFA score, postoperative total bilirubin, showed significant difference between massive ascites group and non-massive ascites group. Another variable that P<0.1 was graft to recipient weight ratio (GRWR) (P=0.069). The two logistic regression showed that preoperative ascites (OR=3.33, P<0.001), postoperative SOFA score(OR=1.25, P=0.027) were independent risk factors for massive ascites after LDLT. The results of Kaplan-Meier analysis showed that the 3-month, 6-month, 1-year survival rates of control group were 89.6%, 81.2%, 79.5% respectively, and those rates of massive ascites group were 80.8%, 80.8%, 74.1% respectively. The survival of the patients who developed massive ascites after LDLT was reduced when compared with control group, but it was not statistically significant. Conclusion Preoperative ascites, postoperative SOFA score were independent risk factors for massive ascites after LDLT. The impact of massive ascites on patients survival need further investigation.