Department of Organ Transplantation Center, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
Transplant Proc. 2024 Jul-Aug;56(6):1390-1395. doi: 10.1016/j.transproceed.2024.03.041. Epub 2024 Jul 14.
Hematomas of the liver graft, that is, postintervention, subcapsular or intrahepatic are rare yet potentially fatal complications following liver transplantation (LT), necessitating immediate diagnosis and management to avert devastating outcomes. This study was aimed to introduce our approach to manage graft hematoma subsequent to LT.
Among 131 orthotopic liver transplantations (OLT) conducted at our institution between January 2017 and May 2023, 3 cases of intrahepatic (n = 2) and extrahepatic (n = 1) hematoma were confirmed through computed tomography (CT) within 10 days after LT. The clinical outcomes of various treatment modalities for these three cases were analyzed.
Three out of 131 (2.3%) LT recipients developed graft hematoma. Patient 1 developed a spontaneous intrahepatic hematoma, without evident predisposing factors, while patient 2 developed an intrahepatic hematoma following endoscopic retrograde cholangiopancreatography (ERCP). The third case that is extrahepatic hematoma was speculated to be a result of minor hepatic parenchymal injury stemming from compressive and volume-reducing manipulation of a large graft, or secondary to focal ischemic necrosis of the liver. Our management protocol was summarized as follows: (1). Immediate ultrasound and CT, particularly enhanced CT; (2). Puncture and percutaneous drainage (PD) of the hematoma; (3). Arterial embolization if the origin could be identified as a ruptured vessel; (4). Surgical evacuation of the hematoma in the presence of bile leakage, to avoid a compartment respectably secondary infection. All three patients responded favorably to treatment and remained alive to date.
Prompt diagnosis and sequential individualized management can successfully deal with intra-/extrahepatic graft hematoma after LT. Our results underscored that an individualized management considering potential future complications into account.
肝移植术后肝内或肝包膜下血肿是肝移植（LT）后罕见但潜在致命的并发症，需要立即诊断和处理，以避免灾难性的后果。本研究旨在介绍我们处理 LT 后肝移植术后肝内血肿的方法。
在我们机构 2017 年 1 月至 2023 年 5 月期间进行的 131 例原位肝移植中，有 3 例肝内（n = 2）和肝外（n = 1）血肿通过 CT 在 LT 后 10 天内确诊。对这 3 例患者的各种治疗方法的临床结果进行了分析。
131 例 LT 受者中有 3 例（2.3%）发生肝移植术后肝内血肿。患者 1 发生自发性肝内血肿，无明显诱发因素，患者 2 在 ERCP 后发生肝内血肿。第 3 例肝外血肿，推测是由于大块肝移植的压迫和体积缩小操作导致肝实质轻微损伤，或继发于肝局灶性缺血性坏死。我们的治疗方案总结如下：（1）立即进行超声和 CT，特别是增强 CT；（2）如果可以确定血肿的来源是破裂的血管，则进行穿刺和经皮引流（PD）；（3）如果存在胆汁漏，动脉栓塞可避免隔室继发感染。所有 3 例患者均对治疗反应良好，且均存活至今。
及时诊断和序贯个体化治疗可以成功处理 LT 后肝内/肝外肝移植术后血肿。我们的结果强调了考虑潜在未来并发症的个体化管理。
