ACUTE VAGINAL BLEEDING IN WOMEN UNDERGOING LIVER-TRANSPLANTATION

OBJECTIVES: Our aim was to define the nature of acute vaginal bleeding problems in women undergoing liver transplantation and to determine t he efficacy of treatments given. STUDY DESIGN: We performed a retrospe ctive chart review of 24 patients undergoing liver transplantation in whom consultation was requested for vaginal bleeding. RESULTS: Twenty- four liver transplant patients were seen for evaluation of acute vagin al bleeding. Two patients were seen before transplantation, and 16 wom en were evaluated for bleeding after transplantation (8 within the fir st 15 postoperative days). In the other eight women abnormal uterine b leeding developed between 2 months and 5 years after transplantation. Five of these women had compromised liver function. In six other women vaginal bleeding originated from extrauterine sources. Six of seven e ndometrial biopsy specimens revealed proliferative endometrium, and th e other showed adenomatous hyperplasia. Three of four patients had a r esponse to progestational agents, bleeding stopped spontaneously in th ree patients, two required hysterectomy, and three died of other cause s. The other five patients were not seen again by us before or after d ischarge from the hospital. CONCLUSIONS: Medical or surgical therapy c an effectively control acute vaginal bleeding in liver transplant pati ents.