Introduction: Liver transplantation is a complex procedure often associated with postoperative complications, including bleeding. Early detection of active bleeding is critical for timely intervention and improved patient outcomes. This retrospective observational study aimed to assess the efficacy of 384-slice CT angiography in detecting early postoperative active bleeding after liver transplantation.
Materials and Methods: A retrospective analysis was conducted on data collected from 53 liver transplant recipients between 01/02/2022 and 26/12/2023. The study population had an age range of 1 to 68 years, with a mean age of 18 years. Notably, 88.37% of the patients fell within the pediatric age range (birth to 18 years). All patients underwent 384-slice CT Angiography with Siemens SOMATOM Force – Dual Source CT. Arterial, venous, and delayed phases with 1 mm slice thickness were obtained. CT scans were performed for patients with symptoms suggesting bleeding.
Results: Approximately 37.74% of the patients experienced bleeding, with 28.30% presenting with active bleeding complications and 9.43% with non-active bleeding complications. Additionally, 3.77% of patients had repetitive bleeding, with one patient experiencing three episodes and another two episodes. All bleeding events originated from the superior paraceliac region near the site of anastomosis, predominantly arterial (97.22%) and only one venous (2.78%). The time intervals between the day of surgery and the onset of active bleeding ranged from day 1 to 14, with a mean time interval of 5.83 days. All patients with active bleeding underwent either conventional angiography or exploratory laparotomy for hemostasis. The site of bleeding was confirmed in all cases.
The sensitivity, specificity, and positive predictive value of 384-slice CT angiography for detecting early postoperative active bleeding were 100%. This indicates that the imaging modality accurately identified all instances of active bleeding, providing a reliable means for prompt intervention.
Conclusions: The advanced capabilities of 384-slice CT, including high resolution, non-invasiveness, high sensitivity, specificity, and positive predictive value advocate for the seamless integration of it into routine postoperative surveillance protocols. This incorporation significantly enhances the timely identification and localization of bleeding sites, leading to improved patient outcomes.