Studies reporting risk factors associated with reoperation due to hemorrhage after orthotopic liver transplantation (OLT) have presented conflicting results and several limitations. In a large contemporary cohort of OLT, we sought to identify independent risk factors associated with increased risk for early return to the operating room (OR) due to hemorrhage after OLT.

We retrospectively studied 225 patients who underwent OLT at Mayo Clinic Arizona between 2018 and 2019. The primary endpoint was same admission return to the OR due to hemorrhage. Univariate analysis was conducted to compare an extensive list of variables amongst reoperated versus non-reoperated patients. A multivariate analysis was then performed to identify independent risk factors associated with reoperation.

Of 225 patients, 29 (13%) required reoperation within the same hospital admission due to hemorrhage. Reoperated patients had longer surgery length, higher intraoperative and post-operative blood loss, and higher transfusion requirements. Upon ICU admission, reoperated patients had comparatively higher APACHE IV predicted mortality and aPTT, and lower hemoglobin, albumin, and blood pH. Reoperated patients had longer ICU stays, hospital stays, and mechanical ventilation requirements. Patients with hepatocellular carcinoma and higher blood albumin level at ICU admission had a reduced need for reoperation. Multivariate analysis identified that higher number of pRBC and cryoglobulin units transfused in the first 24 h after OLT were associated with need of OR reintervention.

Cryoprecipitate transfusion within 24 h of ICU admission, pRBC transfusion within 24 h of ICU admission, and hypoalbuminemia on ICU admission were independent risk factors associated with reoperation due to hemorrhage following OLT. Measurement of these parameters during the postoperative ICU stay may identify patients at increased risk for reoperation.