Objective To explore the risk factors and to develop the management methods of massive perihepatic blood accumulation after liver transplantation. Methods Clinical data of 117 patients, who received performed orthotopic liver transplantation in the Department of Biliary Tract Surgery (Ⅰ) of Eastern Hepatobiliary Surgery Hospital of Second Military Medical University from Mar. 2004 to Apr. 2007, were retrospectively studied to analyze the independent risk factors associated with the occurrence of massive perihepatic blood accumulation by univariate analysis and multivariate analysis, and to summarize the corresponding treatment methods. Results Twelve of 117 cases died in the perioperative period, and 105 cases were included in this study. Among 105 cases, 9 (8.57%) had postoperative massive perihepatic blood accumulation accompanied by aggravated yellowing of the skin and sclera, elevated whole blood leukocyte count and neutrophil proportion in a short period of time, and impaired liver function. Univariate analysis showed the massive perihepatic blood accumulation was associated with a history of upper abdominal surgery (P=0.001), pre-operative hemoglobin (P=0.031), pre-operative leukocyte count (P=0.001), pre-operative platelet count (P<0.001) and post-operative bile leakage (P=0.001); Multivariate analysis showed a history of upper abdominal surgery (P=0.008, OR=15.000) and post-operative bile leakage (P=0.034, OR=20.770) were independent risk factors for massive perihepatic blood accumulation. Conclusion The main methods to prevent massive perihepatic blood accumulation include knowing the history of upper abdominal surgery in patients, strictly protecting the blood supply of bile duct, accurate anastomosis and preventing bile leakage. Puncture or removal of hematocele timely is effective for massive perihepatic blood accumulation.