title: Incidence and management of postoperative abdominal bleeding after liver transplantation.
abstract: OBJECTIVE
  To assess the incidence and management of postoperative abdominal bleeding after orthotopic liver transplantation (OLT) and to identify risk factors for abdominal bleeding.
  
  
  METHODS
  We retrospectively reviewed the medical records of 1039 patients who underwent OLT at our institution from January 2008 to December 2010 seeking to identify subjects with posttransplantation abdominal bleeding, defined as any hemorrhage requiring radiologic intervention or laparotomy within the first month.
  
  
  RESULTS
  Among the 1039 patients, 94 (9%) showed abdominal bleeding, occurring at a mean of 6.1 days (range, day 1 to 21 days). Active bleeding was controlled by endovascular interventional techniques (n = 37; 39%), by surgical ligation or vascular reconstruction (n = 43; 46%), or by sequential combinations of endovascular intervention and surgery (n = 14; 15%). The most frequent bleeding sites for radiologic intervention were the right inferior phrenic artery (n = 14), right and left epigastric arteries (n = 7), intercostal artery (n = 5) and right renal capsular artery (n = 4). The most frequent bleeding sites requiring laparotomy were the hepatic artery (n = 9), diaphragm (n = 8), inferior vena cava (n = 5), abdominal drain insertion site (n = 4), portal vein anastomosis site (n = 4), abdominal wall (n = 3), liver graft cut surface (n = 3), hilar plate (n = 3), and greater omentum (n = 3). Bleeding episodes were associated with greater patient age and increased intraoperative blood loss.
  
  
  CONCLUSIONS
  The risk of bleeding from coagulopathy and iatrogenic injury is high during the early posttransplantation period. This risk of bleeding can be minimized by meticulous surgical dissection and bleeding control.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Jung
authors.forename: J W
authors.initials: JW
authors.lastname: Jung
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: J M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: S Y
authors.initials: SY
authors.lastname: Yoon
authors.forename: C S
authors.initials: CS
authors.lastname: Park
authors.forename: Y H
authors.initials: YH
authors.lastname: Park
authors.forename: H J
authors.initials: HJ
authors.lastname: Lee
authors.forename: H W
authors.initials: HW
authors.lastname: Park
authors.forename: G C
authors.initials: GC
authors.lastname: Park
authors.forename: D H
authors.initials: DH
authors.lastname: Jung
authors.forename: G W
authors.initials: GW
authors.lastname: Song
authors.forename: T Y
authors.initials: TY
authors.lastname: Ha
authors.forename: C S
authors.initials: CS
authors.lastname: Ahn
authors.forename: K H
authors.initials: KH
authors.lastname: Kim
authors.forename: D B
authors.initials: DB
authors.lastname: Moon
authors.forename: G Y
authors.initials: GY
authors.lastname: Ko
authors.forename: K B
authors.initials: KB
authors.lastname: Sung
authors.forename: S G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000005:Abdomen; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000150:complications / Q000628:therapy*