Clinical

Cerebrovascular complications may accompany orthotopic liver transplantation

Last Updated: 2008-12-29 13:08:12 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Chinese researchers report a 3.0% incidence of cerebrovascular complications in a series of patients undergoing orthotopic liver transplantation.

Dr. Jinsheng Zeng and colleagues at Sun Yat-Sen University in Guangzhou, China, retrospectively reviewed the records of 337 patients who underwent 358 liver transplants.

Ten patients (3.0%) developed cerebrovascular complications. There were eight cases of intracranial hemorrhage and two cases of cerebral infarction. Six of the 10 patients died.

The investigators report that the presentations of cerebrovascular accidents in these patients "were similar to common stroke, but with a rapid deterioration at an early stage."

"In our experience, sudden conscious disturbance or loss of consciousness after orthotopic liver transplantation was strongly associated with intracranial hemorrhage," Dr. Zeng and colleagues report in BioMed Central Neurology, available online December 22.

Hematomas were typically "massive, irregular, multifocal and diffuse, and most of them were located at brain lobes" and had a high likelihood of rebleeding and enlarging.

Infarctions were typically lacunar and multifocal, located in the basal ganglia and were likely to become hemorrhagic. Liver transplant recipients may develop cerebral infarctions "due to the hemodynamic change and coagulopathy, then develop hemorrhagic infarction and then deteriorate rapidly," the investigators propose.

Patients with cerebrovascular complications were older and had a higher incidence of systemic infections than patients who did not develop these complications.

The investigators found no significant differences in the incidence of thrombocytopenia, prothrombin time or activated partial prothrombin time between the patients with and without intracranial hemorrhage, "which suggests that the causes of intracranial hemorrhage after orthotopic liver transplantation are multiple and complex; except for coagulopathy, there may be other factors responsible for this complication."

They write, "More effective measures should be taken to prevent post-transplant infection, such as improvement of patients' systemic condition, bacteriologic surveillance and infection control measures."

It is urgent to promptly initiate "systemic antibiotic/antifungal therapy once infection occurs, especially in old patients," Dr. Zeng's team concludes.

BMC Neurology 2008;8.