@article{oai:niigata-u.repo.nii.ac.jp:00006338,
 author = {SATO, Yoshinobu and YAMAMOTO, Satoshi and NISHIMURA, Jun and NABATAME, Nobuyuki and TSUNODA, Kazuhiko and WAKAI, Toshifumi and WATANABE, Takaoki and KUROSAKI, Isao and SHIRAI, Yoshio and HATAKEYAMA, Katsuyoshi},
 issue = {1},
 journal = {Acta medica et biologica, Acta medica et biologica},
 month = {Mar},
 note = {We encountered an early postoperative intra-abdominal massive hemorrhage of above 500ml/hour in a patient having undergone living related liver transplantation for subacute liver failure. Typically, re-exploration would be carried out; however, we successfully managed this patient using conservative procedures. The massive hemorrhage was initially accompanied by a decrease in arterial ketone bodies ratio (AKBR). However, the AKBR then increased rapidly due to blood transfusion. We therefore decided to wait before proceeding with more active measures, though renal function was aggrevated by the bleeding, resulting in anuria. Then, although a second massive hemorrhage occurred, the AKBR did not decrease. Therefore we decided again to wait. Following this, diuretics were seen to gradually increase, and thereafter the intraabdominal hemorrhage ceased rapidly with a surprising increase in urine volume. Renal function was rapidly restored. The decision to proceed with an urgent operation for postoperative massive hemorrhage in patients having undergone liver transplantation is problematic due to the complexity of the patient's situation and the trauma of the initial operation. In this case, the bleeding was considered to originate from the vena cava or cut margin of the graft. Therefore we thought that if the grafted liver's function was restored, clotting would be restored. The AKBR mirrored both the postoperative graft liver function during the hemorrhage and the graft function after therapy. AKBR might play a useful role in the decision-making process regarding the re-exploration of postoperative hemorrhage and the procedures of the operation.},
 pages = {39--43},
 title = {A Case Report of Successful Conservative Management of Postoperative Massive Hemorrhage Based on AKBR after Living Related Liver Transplantation},
 volume = {48},
 year = {2000}
}