Fatal pulmonary embolism during liver transplantation in a patient with fulminant hepatic failure: a diagnostic challenge of the 'flat-line' thromboelastogram.

摘要

COAGULOPATHY AND resultant bleeding diathesis are well-described major problems in orthotopic liver transplantation (OLT). On the other hand, thromboembolism, especially acute pulmonary embolism (PE), has remained a somewhat underappreciated but dreadful complication in OLT.1*2 The incidence of PE with or without intracardiac clot during OLT was reported to be 1.2% in 577 consecutive OLTs in a single institution with in-hospital mortality of 43%.2 A recent retrospective review in the same institution showed PE was observed in 3.3% of 598 consecutive isolated adult OLT patients with operative mortality of 25% and in-hospital mortality of 40%.3