Pretransplant neurological presentation and severe posttransplant brain injury in patients with acute liver failure. Transplantation 2012 Oct 15;94(7):768-74
Date
09/01/2012Pubmed ID
22936036DOI
10.1097/TP.0b013e3182620596Scopus ID
2-s2.0-84867259848 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
BACKGROUND: Alterations in the central nervous system in patients with acute liver failure (ALF) present unique challenges in the perioperative period. In this retrospective study, we examined pretransplant neurological presentation and the incidence, clinical presentation, and risk factors associated with severe posttransplant brain injury (BI) in ALF patients undergoing orthotopic liver transplantation (OLT).
METHODS: After institutional review board approval, ALF patients who underwent OLT between 2004 and 2010 at our center were reviewed. Pretransplant neurological presentation and severe posttransplant BI were examined. Risk factors for the latter were identified.
RESULTS: During the study period, 90 (67 adults and 23 children) ALF patients underwent primary OLT. Preoperatively, all patients developed encephalopathy, 6 had seizure activity, 32 had radiological evidence of cerebral edema, and 11 had severe cerebral edema. After OLT, 7 patients developed severe posttransplant BI. Of these 7 patients, 4 had brain death, and 3 had irreversible injury that precluded them from living independently. Severe pretransplant cerebral edema and a higher posttransplant international normalized ratio (odds ratios and 95% confidence intervals: 50.2, 5.8-433.5 [P<0.001] and 3.1, 1.1-8.8 [P=0.031], respectively) were risk factors associated with severe posttransplant BI.
CONCLUSIONS: Pretransplant neurological complications were prevalent, and severe posttransplant BI occurred at a rate of 7.8% and was significantly associated with severe pretransplant cerebral edema and postoperative international normalized ratio. Our findings support the use of pretransplant computed tomography. If severe pretransplant cerebral edema is confirmed, efforts should be made to aggressively control intracranial pressure and select a proper donor to minimize the risk of severe posttransplant BI and futile transplantation.
Author List
Tan WF, Steadman RH, Farmer DG, Hong JC, Busuttil RW, Apinyachon W, Xia VWMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Brain Death
Brain Edema
Brain Injuries
Central Nervous System Diseases
Chi-Square Distribution
Child
Child, Preschool
Female
Hepatic Encephalopathy
Humans
Incidence
Infant
Liver Failure, Acute
Liver Transplantation
Logistic Models
Los Angeles
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Retrospective Studies
Risk Assessment
Risk Factors
Seizures
Severity of Illness Index
Tomography, X-Ray Computed
Treatment Outcome
Young Adult