The vexing triad of obesity, alcohol, and coagulopathy predicts the need for multiple operations in liver transplantation

Am J Surg. 2022 Jul;224(1 Pt A):69-74. doi: 10.1016/j.amjsurg.2022.02.053. Epub 2022 Feb 19.


Introduction: One in four liver transplants (LT) require return to the operating room(R-OR) within 48 h of surgery. We hypothesize that donor, recipient, and intraoperative factors will predict R-OR.

Methods: LT recipients were enrolled in an observational study to measure coagulation with thrombelastography (TEG) were assessed with transplant recipient and donor variables for risk of R-OR.

Results: 160 recipients with a median age of 55 years and a MELD-Na of 22 were analyzed. R-OR occurred in 22%. Recipient BMI (p = 0.006), donor heavy alcohol use (p = 0.017), TEG MA (p = 0.013) during the anhepatic phase of surgery, TEG MA at anhepatic and 30-min after reperfusion (p < 0.05), and red blood cell transfusions (p < 0.001) were associated with R-OR.

Conclusion: The vexing triad of recipient obesity, heavy donor alcohol use, and low TEG MA were associated with a high rate of R-OR. Strategies to reduce this sub-optimal combination of risk factors could reduce the frequency of unplanned re-operations.

Keywords: Coagulopathy; Damage control surgery; Heavy alcohol use; Liver transplantation; Obesity.

Publication types

  • Observational Study

MeSH terms

  • Blood Coagulation
  • Blood Coagulation Disorders* / etiology
  • Humans
  • Liver Transplantation* / adverse effects
  • Middle Aged
  • Obesity / complications
  • Obesity / surgery
  • Thrombelastography / adverse effects