Korean J Transplant.  2022 Nov;36(Supple 1):S377. 10.4285/ATW2022.F-5158.

Spontaneous rupture of graft hematoma in the second day after right-lobe living-donor liver transplantation: a case report

• Batdelger A
• Amankyeldi Y
• Radnaabazar M
• Byambaragchaa M
• Chogsom M

• KMID: 2535227
• DOI: http://doi.org/10.4285/ATW2022.F-5158

Abstract

Background
Subcapsular hematoma of the graft is an underreported but essential complication after living donor liver trans-plantation. Ruptured liver after liver transplant is a very rare complication. It can lead to loss graft loss. We report a case of a rup-tured liver graft on the second day after living donor liver transplantation.
Methods
A 35-year-old male patient underwent right-lobe living-donor liver transplantation due to hepatitis B virus-related liver cirrhosis and hepatocellular carcinoma (under Milan). The right-lobe graft weighed 719 g, which represented a graft-to-recipient weight ratio of 1.17%. The donor operation procedure was uneventful and no injury during the operation. The recipient operation was performed according to the standard right-lobe living donor liver transplantation procedure. Before abdominal closure, a Doppler echogram study showed that the graft was well perfused, and no parenchymal injury was observed before abdominal closure. The duration and blood loss of the recipient operation was 549 minutes and 900 mL.
Results
Postoperative day 1 Doppler echogram study showed two subcapsular hematomas but normal arterial venous and portal blood flow. On the second day, there was bleeding by drainage, and by echography, the size of the hematoma in segment VI was increased and ruptured. Re laparotomy was performed immediately and evacuated blood clots from the liver surface. Hemostasis was very difficult subcapsular area was packed with surgical and we used a vertical mattress stitch with a straight long needle. The patient has recovered and was discharged 1 month after the transplantation.
Conclusions
Graft rupture post-liver transplantation is rare, few reported cases described ruptured subcapsular hematomas. We believe we would have lost the patient if we elected conservative therapy or interventional procedure Because spontaneous hematomas mostly will need surgery.