title: Management of Liver Allograft Trauma Resulting in Massive Subcapsular Hematoma After Living Donor Liver Transplantation: Can We Salvage the Liver Allograft?
abstract: BACKGROUND Liver allograft trauma resulting in subcapsular hematoma after living donor liver transplantation (LDLT), although rare, is a life-threatening condition and requires prompt management to avoid any catastrophe. Herein we describe our successful experience in dealing with liver allograft hematoma that developed in the post-operative period after LDLT. MATERIAL AND METHODS From January 2002 to May 2015, a total of 616 recipients underwent LDLT at our institute. The intra-operative and postoperative records of these patients were analyzed to study the cases of liver allograft hematoma. Four patients (n=4) who developed liver allograft subcapsular hematoma during the intra-operative and post-operative periods were included in study. The outcomes of these patients were studied after the administration of the medical, surgical, or combined modalities of treatment. RESULTS Out of 616 LDLT recipients, 4 (0.64%) developed subcapsular hematoma. Patients were managed by a stepwise approach: Initial non-operative management with transarterial embolization (if extravasation of the contrast was noticed during imaging studies) was performed (n=1). Three patients developed hemodynamic instability with signs of hematoma rupture and were successfully treated by surgical exploration. CONCLUSIONS Timely diagnosis and suitable management can successfully salvage a liver allograft even in the presence of massive subcapsular hematoma. Our emphasis is on perihepatic packing rather than open surgical drainage if exploration is required, which can achieve a 100% success rate.
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Chao
authors.initials: SC
authors.lastname: Hsu
authors.affiliation: Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Thorat
authors.affiliation: Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Kin-Shing
authors.initials: KS
authors.lastname: Poon
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Te-Hung
authors.initials: TH
authors.lastname: Chen
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Horng-Ren
authors.initials: HR
authors.lastname: Yang
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
mesh_terms: D000328:Adult; D064591:Allografts / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011184:Postoperative Period; D016896:Treatment Outcome