Predictors of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation

Kao, Man-Ling; Lin, Ping‐Yi; Heish, Chia-En; Chou, Chen‐Te; Lin, Kuo‐Hua; Ko, Chih‐Jan; Lin, Chia-Cheng; Chen, Yao‐Li

doi:10.1016/j.ijsu.2013.10.004

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…The A2ALL Consortium reported that 7% of patients who underwent LDLT experienced intra-abdominal bleeding [ 18 ]. Another report showed that 18 (15.3%) developed intra-abdominal hemorrhage in 118 adult LDLT patients [ 19 ]. Although the incidence and mortality rate of bleeding have not been precisely determined, arterial bleeding after liver transplantation has sporadically been reported to be an obvious cause of death [ 20 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Minimal Surgical Manpower for Living Donor Liver Transplantation

Kim

Park

2022

JCM

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Background: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. Methods: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. Results: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36–71); 37 patients (78.7%) were male. The MELD score was 10 (6–40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19–62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7–39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. Conclusions: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management.

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Section: Discussionmentioning

confidence: 99%

Minimal Surgical Manpower for Living Donor Liver Transplantation

Kim

Park

2022

JCM

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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%

“…Of 161 patients included, 32 developed postoperative hemorrhage. Postoperative hemorrhage was defined as persistent drainage of blood from drainage tubes in association with a hemoglobin drop ≥ 2 g/dL 9 or packed red blood cell transfusion with or without fresh frozen plasma (FFP) transfusion, due to a decrease in hemoglobin concentration to < 7 g/dL. Indication for blood transfusion was massive hemorrhage (> 1500 mL) within 24 to 48 hours after surgery.…”

Section: Patients and Definitions Of Hemorrhage After Livingdonor LIVmentioning

confidence: 99%

Untitled

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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