What are the postoperative risk factors for blood loss during liver transplantation?

Updated: Apr 19, 2019
  • Author: Vanessa A Olcese, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
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Postoperative bleeding is not common, but it can occur from leaks at vascular suture lines or bleeding from the cut surfaces at bowel anastomoses. Most of these causes appear to be related to clot lysis or technical failures.

Failure of the graft to function will contribute to postoperative bleeding, causing coagulopathy. In addition, graft versus host disease (GVHD) may occur from the transfer of donor-derived passenger lymphocytes; GVHD often manifests as hemolysis. This type of GVHD is generally limited to the first 4-6 weeks after transplantation and can be controlled by transfusion of donor-specific RBCs.

Less commonly, bleeding after liver transplantation is due to thrombocytopenia. This may result from platelet consumption, platelet-associated immunoglobulin M and immunoglobulin A (IgA) antibody production, sequestration, and thrombin generation. [3] Other causes of thrombocytopenia include viral infection, cytomegalovirus-induced hematophagic histiocytosis, treatment with antiviral agents, and ABO-incompatible GVHD.

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