Morbidity and mortality of iatrogenic hemothorax occurring in a cohort of liver transplantation recipients: a multicenter observational study

Hemothorax (HT) is a life-threatening condition, mainly iatrogenic and poorly explored in Liver Transplantation (LT) recipients. The aim of this study is to report and analyze for the first time incidence and outcomes of HT in LT recipients, as well as to suggest a management strategy. Data concerning 7130 consecutive adult liver and liver-kidney transplant recipients were retrospectively collected from ten Transplantation Centers' institutional databases, over a 10-year period. Clinical parameters, management strategies and survival data about post-operative HT were analyzed and reported. Thirty patients developed HT during hospitalization (0.42%). Thoracentesis was found to be the most common cause of HT (16 patients). A non-surgical management was performed in 17 patients, while 13 patients underwent surgery. 19 patients developed thoracic complications after HT treatment, with an overall mortality rate of 50%. The median length of stay in Intensive Care Units was 22 days (IQR25-75 5-66.5). Postoperative hemothorax is mainly due to iatrogenic causes in LT recipients. Despite rare, it represents a serious complication with a high mortality rate and a challenging medical and surgical management. Its occurrence should always be prevented.