Korean J Transplant.  2022 Nov;36(Supple 1):S351. 10.4285/ATW2022.F-4953.

Massive gastrointestinal bleeding following living donor liver transplantation: a case report

• Ganbaatar B
• Badarch BI
• Batsuuri B
• Orgoi S
• Sainbyan T
• Batjargal G
• Erdene S
• Zandanbazar U
• Tuul M

• KMID: 2535578
• DOI: http://doi.org/10.4285/ATW2022.F-4953

Abstract

Despite advances in anesthesia and surgical techniques manifesting in lower overall transfusion requirements, bleeding is still the most frequent serious early complication following liver transplantation, occurring in approximately 20% of patients. Postoperative bleeding can be life-threatening and requires reoperation in 10%–15% of patients for hemorrhage control and/ or hematoma evacuation. Gastrointestinal bleeding (GIB) occurring after living donor liver transplantation (LDLT) without graft dysfunction could be treated by conventional, endoscopic, or surgical procedures. Therefore, GIB is unlikely to result in death in patients with well-functioning LDLT grafts. However, GIB carries a high mortality risk in patients with graft dysfunction, and retransplantation might be an option. A 56-year-old female with hepatitis B virus, hepatitis D virus liver cirrhosis received LDLT from her healthy daughter. Her body mass index was 23.4 kg/m² and body surface area was 1.6 m² . The massive bleeding was diagnosed by Doppler ultrasound, contrast computed tomography and treated by surgical intervention regarding the patient's underlying comorbidity. Laboratory evaluations included: hemoglobin, 9.9 g/dL; platelet count 37 000 mL, aspartate amino-transferase IU litre; alanine aminotransferase 78 IU litre; albumin, 2.9 g/L; prothrombin time international normalized ratio, 1.37; total bilirubin, 1.8 mg; creatinine, 0.75 mg. In total, 8 units of packed red cells, 10 units of fresh-frozen plasma, and 4 units of platelets were required. After transplantation, further transfusions were required, but the hemodynamic status and laboratory data remained stable (hemoglobin, 10.9 and 9.7 mg and international normalized ratio [INR], 1.25 and 1.06 on postoperative days 5, 6, and 7). Two peritoneal lavages were performed on postoperative day (POD)3 and 4. No further transfusion was re-quired and on postoperative days 1, 2, and 3, hemoglobin was 9.2, and 11.2 g/dL, and INR was 1.12, and 1.13. Computed tomog-raphy performed on POD2 showing large amount of hematoma in anterior peritoneal cavity.