Incidence and Management of Postoperative Abdominal Bleeding After Liver Transplantation

Jung, Jiwon; Hwang, Shin; Namgoong, Jung‐Man; Yoon, Sun-Young; Park, C.S.; Park, Y.H.; Lee, H.J.; Park, Hyung-Woo; Park, G.C.; Jung, Dong‐Hwan; Song, Gi‐Won; Ha, Tae‐Yong; Ahn, Curie; Kim, K.H.; Moon, Deok‐Bog; Ko, Gi‐Young; Sung, Kyu‐Bo; Lee, S.G.

doi:10.1016/j.transproceed.2012.01.011

Cited by 25 publications

(18 citation statements)

References 15 publications

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“…2,9,[12][13][14][15][16] Transient liver dysfunction after liver transplant can potentially cause bleeding , thereby increasing the chance of coagulopathic hemorrhage. Our data show that patients who developed coagulopathic-related hemorrhage had significantly lower preoperative platelet counts, a longer cold ischemia time, and greater estimated blood loss than patients with noncoagulopathic-related hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 There are many factors that contribute to postoperative hemorrhage, including the recipient's preoperative condition (for example, coagulopathy, thrombocytopenia), liver graft condition (donors > 60 years, steatosis), surgical technique (inadequate hemostasis of the cut surface of the remnant liver, blood loss from vascular anastomosis, and prolonged cold ischemia time), and recipient's postoperative condition (early graft dysfunction or primary nonfunction, use of heparin, vascular complications). [3][4][5][6] Regardless of the underlying causes of hemorrhage, hemorrhage after liver transplant can be classified as coagulopathic bleeding (bleeding related to poor graft function and coagulopathy, resulting in continuous oozing of blood) or noncoagulopathic bleeding (bleeding in patients with normal coagulation function).…”

Section: Introductionmentioning

confidence: 99%

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Hsieh

Chou²,

Lin³

et al. 2017

Exp Clin Transplant

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Objectives: Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. Materials and Methods:We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. Results: Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the generalized estimating equation analysis showed that heart rate and central venous pressure differed significantly between the 2 groups of patients. Heart rates increased significantly during hemorrhage (P < .010). Central venous pressure was higher in the coagulopathic group (P = .005) than in the noncoagulopathic group. Conclusions: Lower pretransplant platelet counts, longer cold ischemia time, more blood loss, earlier onset of hemorrhage, and higher central venous pressure level are indicators of coagulopathic hemorrhage after living-donor liver transplant. Key words: Central venous pressure, Cold ischemia time, Computed tomography IntroductionHemorrhage is one of the most common complications after liver transplant, especially during the first postoperative week. 1,2 There are many factors that contribute to postoperative hemorrhage, including the recipient's preoperative condition (for example, coagulopathy, thrombocytopenia), liver graft condition (donors > 60 years, steatosis), surgical technique (inadequate hemostasis of the cut surface of the remnant liver, blood loss from vascular anastomosis, and prolonged cold ischemia time), and recipient's postoperative condition (early graft dysfunction or primary nonfunction, use of heparin, vascular complications). [3][4][5][6] Regardless of the underlying causes of hemorrhage, hemorrhage after liver transplant can be classified as coagulopathic bleeding (bleeding related to poor graft function and coagulopathy, resulting in continuous oozing of blood) or noncoagulopathic bleeding (bleeding in patients with normal coagulation function).Computed tomography (CT) has been reported to be a sensitive modality for detecting active bleeding in patients with major trauma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Untitled

Hsieh

Chou²,

Lin³

et al. 2017

Exp Clin Transplant

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“…The frequency of postoperative bleeding observed in recipients in the present study (5%) was lower than previously reported (8.4% to 14.4%). [3][4][5] A possible reason for this difference may be the different amount of intraoperative blood loss at different centers. The mean intraoperative blood loss observed in this study ( Table 2) was lower than previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…The mean intraoperative blood loss observed in this study ( Table 2) was lower than previously reported. [3][4][5] In addition, intraoperative blood loss was an independent risk factor for postoperative abdominal bleeding after living-donor liver transplant (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…2 Postoperative abdominal bleeding is a potentially life-threatening complication after liver transplant and often requires surgical treatment. 3 Delay in the diagnosis and treatment of postoperative abdominal bleeding may cause death. Identifying the cause of postoperative bleeding is necessary to decrease the incidence of this complication.…”

Section: Introductionmentioning

confidence: 99%

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Wen²,

Yan³

et al. 2014

Exp Clin Transplant

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Hemostatic status in liver transplantation: Association between preoperative procoagulants/anticoagulants and postoperative hemorrhaging/thrombosis

et al. 2015

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The delicate rebalanced hemostatic status of liver transplant recipients may lead to both hemorrhagic and thrombotic tendencies in this population. The aim of this study was to investigate the association between pretransplant procoagulants/ anticoagulants and posttransplant bleeding and thrombosis among living donor liver transplant recipients. The study subjects were 403 consecutive recipients with chronic liver disease. Perioperative variables, including preoperative values for procoagulants and anticoagulants, were assessed to determine their association with posttransplant hemorrhaging and thrombosis. There were 35 hemorrhagic complications (9%) and 21 thrombotic complications (5%). In logistic regression analyses, a higher Model for End-Stage Liver Disease score (P 5 0.01) and a lower fibrinogen value (P < 0.001) were independently associated with hemorrhaging, whereas only a lower protein C value (P < 0.001) was independently associated with thrombosis. In a receiver operating characteristic analysis, a low preoperative protein C value (with the most accurate cutoff value being 25%) was a reliable predictor of thrombotic complications after liver transplantation (area under the curve 5 0.921, P < 0.001, sensitivity 5 0.9, specificity 5 0.8). In conclusion, the decreases in both procoagulants and anticoagulants in liver transplant recipients may additively result in a delicate hemostatic balance and predispose patients to both hemorrhagic and thrombotic complications. A lower preoperative protein C value (<25%) was demonstrated to be a significant and reliable predictor of postoperative thrombotic complications in liver transplant recipients. Liver Transpl 21:258-265, 2015. V C 2014 AASLD.

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Incidence and Management of Postoperative Abdominal Bleeding After Liver Transplantation

Cited by 25 publications

References 15 publications

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Hemostatic status in liver transplantation: Association between preoperative procoagulants/anticoagulants and postoperative hemorrhaging/thrombosis

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