title: Clinical significance of gastrointestinal bleeding after living donor liver transplantation.
abstract: The clinical presentations of gastrointestinal bleeding (GIB) occurring after living donor liver transplantation (LDLT) have not been fully described. We performed a retrospective analysis of 297 LDLT cases. Nineteen patients (6.4%) experienced GIB after LDLT. The etiology of GIB included bleeding at the jejunojejunostomy following hepaticojejunostomy (n = 13), peptic ulcer disease (n = 2), portal hypertensive gastropathy (n = 2), and other causes (n = 2). Hemostasis was achieved in 13 patients (68.4%) by endoscopic (n = 3), surgical (n = 1), or supportive treatments (n = 15), but not in the other six patients. Graft dysfunction (P < 0.001), hepaticojejunostomy (P = 0.01), portal vein pressure at the end of surgery >20 mmHg (P = 0.002), and operative blood loss >10 L (P = 0.004) were risk factors. One-year graft survival rate was significantly lower in patients with GIB than in patients without GIB (P < 0.001). The inhospital mortality rate was 52.6% for patients with GIB, 75.0% for patients with graft dysfunction, and 14.3% for patients without graft dysfunction (P = 0.028). Despite its infrequency after LDLT, GIB has strong correlation with graft dysfunction and inhospital mortality.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kimura
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuki
authors.initials: Y
authors.lastname: Bekki
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Shohei
authors.initials: S
authors.lastname: Yoshiya
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Noboru
authors.initials: N
authors.lastname: Harada
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D012189:Retrospective Studies
keywords: gastrointestinal bleeding; graft dysfunction; living donor liver transplantation