Addressing Certain Risk Factors May Decrease Likelihood of a Patient With a Liver Transplant Returning to Operating Room


Obesity, heavy alcohol consumption, and coagulopathy were some of the greatest risk factors associated with patients returning to the operating room within 48 hours of a surgery.

Certain risk factors can increase the risk of liver transplant patients needing to return to the operating room (R-OR) within 2 days of their original surgery. The risk factors associated with a 100% R-OR include obesity, heavy alcohol consumption, and coagulopathy, according to study data. To mitigate the risks of such complications, steps may need to be taken to address these issues in advance of a liver transplant surgery to decrease the likelihood of R-OR.

“What this tells us is that, if possible, we should try to not match a recipient with obesity with a donor who has a history of alcohol use,” said study principal investigator Hunter Moore, MD, PhD, an assistant professor of transplant surgery in the University of Colorado School of Medicine, in a press release.

Moore found that R-OR occurred most often in obese patients with a BMI of 30 or higher. Based on this observation, the researchers evaluated obesity as a possible risk factor for a second liver operation, as well as other associated risk factors and modifiable risks that may help to prevent a second operation.

Looking at data from 160 liver transplant recipients who were enrolled in the Colorado Multi-Institutional Review Board study, researchers observed a possible association between weight and alcohol. Based on the data, researchers observed that among participants with a BMI of 30 or higher, 80% were back in the OR within 48 hours of the first surgery if their donor drank 2 or more servings of alcohol daily.

“When I see my pre-evaluation liver transplant patients, if they have a BMI that’s 30 or higher, I let them know that if they can work toward getting their BMI below 30 it may reduce their risks of returning to the OR and improve their outcomes,” Moore said in the press release.

Another risk factor that leads to patients who have received a liver transplant needing to go back to the operating room within 48 hours is having a hematoma (pool of clotted blood) around their new liver.

“During the transplant operation, the liver is a little slow and takes a while to wake up, which results in slow coagulopathic bleeding which cases blood to coagulate around it,” Moore said in the press release.

Moore explained that this phenomenon, while not usually harmful for patients, puts too much pressure onto the liver. It can slow down recovery and necessitates reoperation. Moore added that minimizing this risk factor is not always possible, but surgeons can “more aggressively” manage it if high BMI or excessive alcohol consumption are not also risk factors.

The team hopes to conduct future research on the risk factors of liver donors that could negatively impact the liver transplant patient.

“One of our main goals is to better understand risk factors so that we can anticipate outcomes and better plan for them during and after surgery,” Moore said in the press release.


University of Colorado Anschutz Medical Campus. Obesity, alcohol use, and decreased blood clotting associated with return to operating room after liver transplant. EurekAlert! August 26, 2022. Accessed on August 29,2022.

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