title: Predictors of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation.
abstract: BACKGROUND
  Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are predictive of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation surgery.
  
  
  METHODS
  During the period from January 2009 to December 2012, 118 adults underwent living donor liver transplantation (LDLT) in our institution. Of those patients, 18 (15.3%) developed intra-abdominal coagulopathic hemorrhage (n = 7) or hemorrhage due to non-coagulopathic causes (n = 11) that required emergency medical, radiological, or surgical intervention within the first month after LDLT. Possible predictors of postoperative coagulopathic hemorrhage included donor-related factors, age, body mass index, MELD score, INR value, intra-operative blood transfusion, graft/recipient weight ratio, anhepatic phase, cold ischemia time, operative time, APACHE II score, onset of re-bleeding, and hemoglobin levels during rebleeding episodes.
  
  
  RESULTS
  There were no differences in any of the variables between the two groups (coagulopathic and noncoagulopathic hemorrhage) except for cold ischemia time. We found that cold ischemia time was significantly longer in patients with postoperative coagulopathic hemorrhage (160.50 ± 45.02 min) than in patients with hemorrhage due to non-coagulopathic causes (113.55 ± 29.31 min; P = 0.027).
  
  
  CONCLUSIONS
  Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.
authors.affiliation: Department of Surgical Critical Care, Changhua Christian Hospital, Changhua, Taiwan, ROC.
authors.forename: Man-Ling
authors.initials: ML
authors.lastname: Kao
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Lin
authors.forename: Chia-En
authors.initials: CE
authors.lastname: Heish
authors.forename: Chen-Te
authors.initials: CT
authors.lastname: Chou
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Lin
authors.forename: Chih-Jan
authors.initials: CJ
authors.lastname: Ko
authors.forename: Chia-Cheng
authors.initials: CC
authors.lastname: Lin
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000005:Abdomen / Q000098:blood supply; D000328:Adult; D000368:Aged; D050377:Cold Ischemia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
keywords: Coagulopathic hemorrhage; Cold ischemia time; Hepatic artery; Living donor liver transplantation