Background: Ruptured liver after transplant is a rare complication. It can lead to graft or patient loss. Few reports are available in literature.
Case Report: A 58 y old male patient underwent a deceased donor liver transplant due to hepatitis B virus related cirrhosis. The donor was a 38 y old trauma victim. There were no obvious injuries involving the liver during organ recovery but multiple petechiae appeared on the surface of the right lobe after preservative solution infusion. The transplant procedure was uneventful. The patient recovered quickly. On the second day the patient developed severe hypotension and laparotomy showed a deep laceration in the right lobe separating the anterior and posterior  sectors. Massive blood transfusion was needed. Homeostasis was extremely difficult and partial right lobe resection needed to control bleeding. The patient recovered and was discharged two weeks after the transplant.
Conclusions: Hematomas secondary to interventional procedures may be treated conservatively but spontaneous hematomas mostly will need surgery. The presence of petechiae on the surface of the graft may indicate a high energy injury and the possibility of intrahepatic hematoma that may rupture after implantation.

Keywords: Liver, Hematoma, graft, Rupture