Gastrointestinal Perforation After Liver Transplant: A Single Center Experience

Objectives: The aim of this study was to evaluate the incidence, possible risk factors, clinical presentation, and follow-up of patients with a gastrointestinal perforation after liver transplant. Materials and Methods: We did a retrospective chart review of all patients who presented with a gastrointestinal perforation after liver transplant at our liver transplantation center between December 2009 and June 2011. Results: In total, we performed 271 liver transplants during this period. Nine patients (3.3%), 5 pediatric and 4 adult patients (median age, 21.3 +/- 16.2 y; range, 1-55 y), developed a gastrointestinal perforation after liver transplant. Six of the patients had living donors, and 3 had deceased-donor transplants. Four patients underwent prior abdominal surgery for unrelated reasons. The mean time between liver transplant and diagnosis of the gastrointestinal perforation was 12.9 +/- 9.3 days (range, 4-30 d), and the mean hospitalization length was 50 +/- 29.3 days (range, 18-102 d). Perforations were located in the stomach (n = 1), jejunum (n = 3), ileum (n = 2), jejunum and ileum (n = 1), and colon (n = 2). Seven patients were managed by ostomies, and 2 by primary repair. Despite administration of proper antibiotic therapy and fluid resuscitation to all patients, 2 adults died of septic shock: 1 was caused by perforation and 1 was caused by anastomotic leakage after colostomy closure. Conclusions: A gastrointestinal perforation after a liver transplant is a rare but mortal complication. Considering delayed wound healing owing to immunosuppression, potentially larger ischemic tissue around the perforation site owing to cautery burns and the atypical clinical course that may be further masked by bile leakage, ostomy treatment should be preferred to primary repair. A loop ostomy for small and large bowel perforations after the liver transplant decreases mortality and morbidity.