Management of subcapsular hematoma of the graft after living donor liver transplantation

Subcapsular hematoma of the graft is a serious complication of liver transplantation (LT), and there has been no discussion in the literature about optimal management except in sporadic case reports. The aim of this work is to review our experience of subcapsular hematoma in living donor liver transplantation (LDLT) and to introduce our management strategy. Among the 818 cases of adult-to-adult LDLT between February 1997 and November 2005, there have been 4 cases of subcapsular hematoma. Two of these developed after percutaneous liver biopsy and the other 2 developed after percutaneous transhepatic biliary drainage (PTBD). Two developed immediately after the procedure, whereas the other 2 developed 8 and 12 days after the procedure, respectively, due to rupture of a pseudoaneurysm. Our management strategy was as follows; after performing dynamic computed tomography for initial diagnosis, these 3 steps were taken: 1) hepatic arteriography and selective embolization of bleeding focus; 2) pigtail catheter drainage (PCD) of subcapsular hematoma; and 3) hepatic vein stenting if there was a sign of outflow disturbance due to compression by a large hematoma. All 4 of our patients recovered from the insult of subcapsular hematoma. In conclusion, our results indicate that patients who develop subcapsular hematoma after LDLT can be treated nonsurgically.