Gastrointestinal complications of hepatic transplantation

In this series of 150 orthotopic hepatic transplants, clinically significant gastrointestinal hemorrhage occurred in 34 patients (23%). Five patients (15%) survived this complication. Enteric perforations occurred in 20 patients following 198 biliary-enteric procedures. Only one patient survived. Enteric perforations unrelated to biliary procedures fared only slightly better with one survivor among eight perforations. These results clearly do not warrant complacency. Modifications advocated are an aggressive diagnostic approach and early reoperation with establishment of extensive peritoneal drainage where necessary.