Acute Neurological Complications After Liver Transplantation with Particular Reference to Intraoperative Cerebral Air Embolus

Abstract

Nine of 48 adult patients who underwent orthotopic liver transplantation developed significant clinical neurological abnormalities recognized shortly after operation. Decrease in consciousness Otturred with resultant coma, focal and generalized seizures and the Ottasional appearance of a state or akinetic mutism. Neuropathologiall abnormalities consisted of mulUfocal areas of inrarction in cerebral cortex and basal ganglia in five patients, «Htral pontine myelinolysis in five (often more extensive than usuaUy reported), Wernicke's encephalopathy in three, cfiaI nodules in two, and fungal abscesses in OM. Alzheimer II astrocytosis was round in aU brains available for retrospective study. There was direct evidence in two of the patients that air embolization rrom the homografts had occurred. Correlation or this with the brain inrarcts in these and other cases seems reasonable. The ease with wbk:b air passed to tbe systemic circulation is explicable by the right to left venousarterial shunts that are common in cbronic liver disease. With the delineation of this cause ror tbe neurologic complications, measures to prevent it in future cases have been described. A MONG ADULTRECIPIENTS of orthotopic liver homografts. a high incidence of acute and profound neurologic disability has been recognized shortly after operation. 21 We rePOrt here a brief clinical-neuropathological survey of these central nervous system complications. Particular emphasis will be placed on the possible etiologic role. in some instances, of air emboli originating from the hepatic homograft. and on the avoidance of such emboli in future cases,

Neurologic complications of liver transplantation in adults

“…2,13,14 The Birmingham study and others from abroad have suggested that neurologic complications occur in about 30% of patients and that these patients have a higher mortality and morbidity. 3,4,[6][7][8][9][10][11]13,[15][16][17] Although the overall survival of these patients posttransplant has improved dramatically over the years with the introduction of new surgical, medical, and, in particular, immunosuppressive techniques, there has been little change in the incidence of neurologic complications. In 1978, a study found neurologic complications in 19% of patients, 16 and 9 years later, in 1987, this figure was 33% of patients.…”

A model to predict the development of mental status changes of unclear cause after liver transplantation

“…[1][2][3][4][5][6] These complications are a major cause of morbidity and mortality after LT. 7 In addition, post-LT neurological complications increase health care costs (mainly because of prolonged hospitalization) and worsen the health-related quality of life of these patients. 8 The most frequent clinical presentations are mental status changes (ranging from delirium to frank coma) with or without seizures.…”

Rehabilitation of Two Cases Neurologic Complications Following Solid Organ Transplantation

“…Their sizes are small and medium. 21 As our patient had infarction, her prognosis was considered to be relatively good and was potentially placed into the rehabilitation program.…”