Gastrointestinal perforation after liver transplantation

Aim: The aim of the present study was to evaluate the risk factors and outcomes of gastrointestinal perforation post-liver transplantation. Patients and Methods: Eleven patients were found to have complications as a result of gastrointestinal perforation post-liver transplantation at our centre from May 2008 to February 2014. Seven of these patients were selected for statistical analysis. Each patient was randomly matched with six recipients in age (+/- 10 years), primary disease and sex. Factors, including cold ischaemic time, blood loss volume, previous hepatobiliary surgery history and 1-year survival rate, were compared between the two groups. Results: The sites of perforation were the stomach (n = 2), duodenum (n = 2), jejunum (n = 1), ileum (n = 3) and colon (n = 3). Univariate analysis showed a significant difference in previous hepatobiliary surgery history (P < 0.01). No difference was found in portal venous cross-clamp time, cold ischaemic time, model for end-stage liver disease score, body mass index, steroid therapy or blood type incompatibility. Previous hepatobiliary surgery history was found to be an independent risk factor in the multivariate analysis (P < 0.05). The 1-year survival rate was lower in the perforation group (P < 0.01). Conclusion: Gastrointestinal perforation leads to a high rate of morbidity and mortality, and significantly decreases graft and recipient survival. A history of hepatobiliary surgery is a risk factor of this complication. Careful dissection and avoiding iatrogenic injury during operation are important.