Spontaneous hemobilia after liver transplantation: Frequency, risk factors, and outcome of endoscopic management

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Background and Aim:

Spontaneous hemobilia is an uncommon liver transplantation (LT)-related biliary complication. The frequency, etiology, and mechanism of spontaneous hemobilia after LT are not known. This study aimed to assess the outcome of endoscopic management for spontaneous hemobilia after LT, and to investigate its frequency and risk factors.


The records of patients who underwent endoscopic retrograde cholangiopancreatography to manage hemobilia after LT at the Asan Medical Center, Korea, between January 2006 and April 2014 were retrospectively reviewed.


A total 2701 cases of LT was performed in the study period, and 33 LT patients with spontaneous hemobilia were included in the study group. Endoscopic nasobiliary drainage was achieved in 33 cases (100%). In 29 of 33 patients (87.9%), hemobilia was improved. The frequency of spontaneous hemobilia was 1.22% (33/2701). On multivariate analysis, United Network for Organ Sharing status I or IIa (odds ratio [OR] 3.095, 95% CI 1.097–8.732, P = 0.033), alcoholic liver cirrhosis (OR 3.942, 95% CI 1.261–12.324, P = 0.018), and body mass index < 24.5 kg/m2 (OR 2.329, 95% CI 1.005–5.397, P = 0.049) were significant risk factors for spontaneous hemobilia after LT.


Endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage are feasible methods for the management of spontaneous hemobilia after LT. In patients with United Network for Organ Sharing status I and IIa, alcoholic liver cirrhosis, or body mass index < 24.5 kg/m2, special attention should be paid to the occurrence of spontaneous hemobilia after LT.

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