Cerebrovascular events in 20 years of follow‐up after liver transplantation: an underestimated issue?

Schoening, Wenzel; Buescher, Niklas; Neidel, Nadja; Helbig, Michael; Ανδρέου, Ανδρέας; Pascher, Andreas; Bahra, Marcus; Pratschke, Johann; Seehofer, Daniel

doi:10.1111/ctr.12819

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…Several aspects of cerebrovascular diseases in LT recipients have been investigated, including prevalence and related risk factors [22][23][24].…”

Section: Cerebrovascular Diseasesmentioning

confidence: 99%

“…To test whether LT might have an effect on the incidence of cerebrovascular events, i.e., stroke or transient ischemic attack (TIA), a retrospective cohort of 313 LT recipients were studied according to their PROCAM Stroke scores and their 20-year follow-up [24]. In this study population, the risk of cerebrovascular events in LT recipients was 3.5-fold higher that it was during the first 10 years and 2-fold higher in the second decade after LT than it was in "the standard population" (Table 2).…”

Section: Cerebrovascular Diseasesmentioning

confidence: 99%

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Cerebral Diseases in Liver Transplant Recipients: Systematic Review of Clinical Evidence

Dudek

Andruszkiewicz

Gelo

et al. 2022

JCM

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This systematic review presents clinical evidence on early and long-term cerebral diseases in liver transplant recipients. The literature search led to the retrieval of 12 relevant studies. Early postoperative cerebral complications include intracranial hemorrhage associated with a coexisting coagulopathy, perioperative hypertension, and higher MELD scores and is more frequent in critically ill recipients; central pontine and extrapontine myelinolysis are associated with notable perioperative changes in the plasma Na+ concentration and massive transfusion. Long-term follow-up cerebral complications include focal brain lesions, cerebrovascular diseases, and posterior reversible encephalopathy; there is no proven relationship between the toxicity immunosuppressive drugs and cerebral complications. This SR confirms a very low incidence of opportunistic cerebral infections.

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“…Several aspects of cerebrovascular diseases in LT recipients have been investigated, including prevalence and related risk factors [22][23][24].…”

Section: Cerebrovascular Diseasesmentioning

confidence: 99%

Section: Cerebrovascular Diseasesmentioning

confidence: 99%

Cerebral Diseases in Liver Transplant Recipients: Systematic Review of Clinical Evidence

Dudek

Andruszkiewicz

Gelo

et al. 2022

JCM

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“…Increasing age of the recipients and high incidence of cardiovascular risk factors, but also calcineurin inhibitor treatment, are positive predictors. Schoening et al showed that the risk of cerebrovascular events was around 3.5 times higher in the first decade after LT and 2 times higher in the second decade after LT compared with the standard population 55…”

Section: Non-rhe Pltementioning

confidence: 99%

<p>Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?</p>

Kornerup¹,

Pflugrad²,

Weißenborn³

et al. 2019

HMER

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Liver transplantation (LT) represents the definitive treatment for end-stage liver disease. Cognitive impairment following LT is frequent, referred to as postliver transplant encephalopathy (PLTE). LT removes the underlying chronic liver disease, and until recently hepatic encephalopathy (HE) was assumed to be fully reversible after LT. However, increasing evidence indicates that some degree of cognitive impairment may be present after LT. To which extent PLTE reflects cognitive impairment caused by residual HE (RHE) or the combined effect of other factors affecting brain function before, during, and after LT is not clarified. None of the available psychometric and neurophysiological tests used for detecting HE is shown to be able to distinguish between etiologies. The available, mostly retrospective, clinical studies indicate a high prevalence of abnormal psychometric tests after LT, and not all seem to recover completely. The patients with earlier HE show the most marked improvements, suggesting that the clinical picture of the early PLTE, in fact, represents RHE. Other early post-LT etiologies for PLTE comprise cerebral ischemia, critical illness encephalopathy, and immunosuppressive therapy. Late-onset etiologies comprise diabetes and hypertension, among others. PLTE regardless of etiology is a worrying issue and needs more attention in the form of mechanistic research, development of diagnostic/discriminative tools, and standardized prospective clinical studies.

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“…Solid organ transplantation has become the definitive and life‐saving treatment for patients with end organ disease. Although graft complications and infections are still the main causes of mortality, long‐term outcomes after transplantation can be substantially influenced by other postoperative complications related to thromboembolism and cardiovascular events .…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular disease risk in patients receiving organ transplantation: a national cohort study

et al. 2017

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Although organ transplantation is the definitive treatment for end-stage organ failure, the post-transplant outcomes can be substantially influenced by cardiovascular complications. A national cohort study was performed to estimate risks of cardiovascular diseases in those with heart, lung, kidney, and liver transplantation. This cohort study consisted of 5978 solid organ transplantations identified using the Taiwan National Health Insurance Database. Cardiovascular and mortality risks in transplant recipients were evaluated using standardized incidence ratios, excess absolute risks, and standardized mortality ratios as compared to those in the general population. In heart, kidney, and liver recipients, the standardized incidence ratios of overall cardiovascular diseases were 9.41 (7.75-11.44), 3.32 (2.29-3.77), and 1.4 (1.15-1.7) and the overall standardized mortality ratios were 5.23 (4.54-6.03), 1.48 (1.34-1.63), and 3.95 (3.64-4.28), respectively. Except for heart organ recipients who were at highest risk for coronary artery disease with a standardized incidence ratio of 13.12 (10.57-16.29), kidney and liver organ recipients had a ninefold increased risk in developing deep vein thrombosis post-transplant. In conclusion, solid organ transplant patients are at risk of cardiovascular disease, in particular, deep vein thrombosis, which may warrant early identification of high-risk patients in addition to prompt and adequate thromboprophylaxis perioperatively.

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Cerebrovascular events in 20 years of follow‐up after liver transplantation: an underestimated issue?

Cited by 7 publications

References 32 publications

Cerebral Diseases in Liver Transplant Recipients: Systematic Review of Clinical Evidence

Cerebral Diseases in Liver Transplant Recipients: Systematic Review of Clinical Evidence

<p>Cognitive impairment after liver transplantation: residual hepatic encephalopathy or posttransplant encephalopathy?</p>

Cardiovascular disease risk in patients receiving organ transplantation: a national cohort study

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