28 January 2016 : Original article
Post-Operative Hemorrhage After Liver Transplantation: Risk Factors and Long-Term Outcome
Harald SchremABCDEFG, Annika KlußmannBCDEF, Moritz FockenBE, Nikos EmmanouilidisBDE, Felix OldhaferBDE, Jürgen KlempnauerBDEG, Alexander KaltenbornABCDEFGDOI: 10.12659/AOT.895605
Ann Transplant 2016; 21:46-55
Abstract
BACKGROUND: Increasing scarcity of donated liver grafts clearly demonstrates the desperate need for ongoing outcome analysis to improve patient and graft survival after liver transplantation. Coagulation is often severely deteriorated in patients suffering from liver disease, thus leading to bleeding complications after liver transplantation.
MATERIAL AND METHODS: We included 770 liver transplantations in this single-center retrospective analysis to identify independent risk factors for post-operative hemorrhage. The relevance of bleeding complications was assessed with special regards to coagulation-related variables. Multivariate regression analyses allowed weighing of different risk factors.
RESULTS: Post-operative hemorrhage leading to revision surgery was observed in 19.9% (n=153 cases) of cases and was revealed as an independent risk factor for mortality (p=0.014; HR: 1.457; 95%-CI: 1.081–1.964). Risk-adjusted multivariate regression analysis compiling all pre- and intra-operative donor and recipient variables revealed that only the number of transfused packed red blood cells (p<0.001; OR: 1.072; 95%-CI: 1.036–1.110), hepatitis B virus-related liver disease (p=0.019; OR: 0.082; 95%-CI: 0.010–0.666), model of end-stage liver disease-era (p=0.020; OR: 1.016; 95%-CI: 1.002–1.029), partial thromboplastin time at transplantation (p=0.021; OR: 1.016; 95%-CI: 1.002–1.029), and donor intensive care unit stay in days (p=0.009; OR: 1.009; 95%-CI: 1.002–1.016) were significantly associated with the occurrence of post-operative hemorrhage.
CONCLUSIONS: Post-operative hemorrhage relevantly contributed post-transplant mortality. Avoidance of excessive packed red blood cell use during transplantation and short donor-intensive care unit stay lead to a decreased rate of bleeding complications. Coagulations state at transplantation is also relevant for favorable outcome.
Keywords: Blood Platelets, Hemorrhage, Liver Transplantation, Platelet Count, Thrombocytopenia
SARS-CoV-2/COVID-19
17 June 2022 : Case report
Extrapulmonary Manifestations of SARS-CoV-2: A Report of 3 Cases and a Literature ReviewAnn Transplant In Press; DOI: 10.12659/AOT.935874
12 April 2022 : Letter/Correspondence
Pancreas Allograft Thrombosis as a Post-COVID-19 Complication in a Diabetic Patient After Pancreas Transpla...Ann Transplant 2022; 27:e935863
12 November 2021 : Original article
Coronavirus Disease 2019 (COVID-19) in Solid Organ Transplant Recipients: A Case-Control StudyAnn Transplant 2021; 26:e933152
26 October 2021 : Original article
Safety of Antithymocyte Globulin Use in Kidney Graft Recipients During the COVID-19 PandemicAnn Transplant 2021; 26:e933001
In Press
23 Jun 2022 : Original article
Evaluation of Deceased Donor Kidney Transplantation in the Eurotransplant Senior Program in Comparison to S...Ann Transplant In Press; DOI: 10.12659/AOT.936514
21 Jun 2022 : Case report
Extrapulmonary Manifestations of SARS-CoV-2: A Report of 3 Cases and a Literature ReviewAnn Transplant In Press; DOI: 10.12659/AOT.935874
20 Jun 2022 : Original article
The Association Between Tacrolimus Levels and Hyperkalemia in Allograft Recipients Who Underwent Heart or L...Ann Transplant In Press; DOI: 10.12659/AOT.935607
15 Jun 2022 : Original article
Donor CYP3A5 Expression Decreases Renal Transplantation Outcomes in White Renal Transplant RecipientsAnn Transplant In Press; DOI: 10.12659/AOT.936276
Most Viewed Current Articles
26 Jan 2022 : Review article
Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive ModelsDOI :10.12659/AOT.934924
Ann Transplant 2022; 27:e934924
29 Dec 2021 : Original article
Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...DOI :10.12659/AOT.933588
Ann Transplant 2021; 26:e933588
24 Jul 2020 : Review article
Kidney Transplantation in the Times of COVID-19 – A Literature ReviewDOI :10.12659/AOT.925755
Ann Transplant 2020; 25:e925755
15 Mar 2022 : Case report
Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...DOI :10.12659/AOT.935860
Ann Transplant 2022; 27:e935860