Correct statement(s) concerning postoperative complications after hepatic transplantation include:

a. Primary nonfunction occurs in 5 to 10% of transplanted livers in the immediate postoperative period

Primary nonfunction of the allograft occurs in about 5% to 10% of transplanted livers. Most cases of nonfunction are related to inadequate tissue preservation or occult organ dysfunction in the donor but a sizeable percentage may arise from immunologic mechanisms. In the worst case scenario, the patient does not regain consciousness, a coagulopathy ensues, and multiple organ failure develops. Liver enzymes show hepatocellular injury with SGOT and SGPT values in the range of 5000 to 10,000 and little bile production. Hepatic artery thrombosis occurs in 5% of adult hepatic transplantation cases and up to 25% of pediatric cases. Postoperative vein thrombosis is much less common than hepatic artery thrombosis, occurring in 2% to 3% of cases. Laparotomy to control postoperative bleeding is required in 15% of cases. In about half of the reoperations, a specific bleeding point is identified. Survival is higher in these cases in contrast to those in which diffuse bleeding is encountered, presumably since the latter circumstance is usually associated with poor allograft function and resultant coagulopathy. If significant bleeding occurs after hepatic transplantation, a common and sensible policy is to transfuse the patient until hypothermia and coagulopathy are corrected with subsequent (one to three days) evacuation of blood from the peritoneal cavity. Biliary leakage is a feared complication, with a high (50%) mortality. The high mortality may be the result of a concomitant hepatic arterial thrombosis and infection of the leaked bile, or difficulty of bile duct repair in the area of inflamed tissue.