Neurologic Complications of Liver Transplantation

Aj, Martínez; Estol, Conrado J.; Aa, Faris

doi:10.1016/s0733-8619(18)30873-9

Cited by 67 publications

(33 citation statements)

References 61 publications

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“…Neurologic complications are the most important causes of morbidity and mortality in liver transplant recipients [1,2,3,4,5], with seizures being one of the leading complications, having a frequency between 2.8 and 42% [1, 3,5,6,7,8]. Etiologies of seizures include infection, stroke, central pontine myelinolysis, and acute metabolic insults induced by immunosuppressive therapy [1,5,6,7,8,9,10]. It is often difficult to establish the precise causes of seizures in patients who have undergone OLT, however, because multiple potential causes may be present.…”

Section: Introductionmentioning

confidence: 99%

New-Onset Seizures after Liver Transplantation: Clinical Implications and Prognosis in Survivors

et al. 2004

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Purpose: To identify the probable etiologies and characteristics of new-onset seizures after orthotopic liver transplantation (OLT) and to assess their clinical implications and prognosis. Methods: We retrospectively analyzed the clinical, electrophysiologic and laboratory data of 17 patients with new-onset seizures after OLT among 367 adult and pediatric patients who underwent OLT between 1999 and 2001. Results: A suspected etiology of seizures was identified in most patients, including 6 (35.2%) with neurotoxicity due to immunosuppressive therapy, 4 (23.5%) with cerebrovascular disease, 3 (17.6%) with severe metabolic derangement by sepsis or rejection, and 1 each (5.8%) with hyperglycemia and brain edema due to fulminant hepatic failure. Causative factors could not be identified in 2 patients (11.8%). Seizures recurred in 15 patients (88.2%), with 9 occurring on the same day as the original seizure. Attacks caused by neurotoxicity tended to have an earlier onset, within 1 week in 4 of 6 patients, than those caused by cerebrovascular disease and sepsis/rejection, but this was not statistically significant. A total of 21 EEGs were performed in 13 patients. Eleven patients had abnormal EEG findings, of whom 4 (30.7%) showed epileptiform discharges, but the outcome of patients with epileptiform activity did not differ statistically from that of patients without such discharges (p > 0.6). The incidence of poor outcome (death or persistent vegetative state) in the group with seizures was almost 10 times higher than in the group without seizures (52.9 vs. 5.7%, p < 0.001). The prognosis of patients with seizures due to cerebrovascular disease and severe metabolic derangement by sepsis/rejection was poorer than that of patients with seizures caused by the neurotoxicity of immunosuppressive drugs (p < 0.02), suggesting that the underlying cause of seizures is important in determining prognosis. Of 8 patients who survived, 1 was lost to follow-up. The long-term outcome of seizures in surviving patients was excellent, with all survivors available for follow-up being seizure-free for a mean follow-up of 42.5 months (range, 16–58 months). Conclusion: New-onset seizures after OLT may herald fatal outcome, especially in patients with cerebrovascular disease or sepsis. The prognosis of seizures in survivors is excellent, and long-term antiepileptic drugs are not required in most cases.

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Section: Introductionmentioning

confidence: 99%

New-Onset Seizures after Liver Transplantation: Clinical Implications and Prognosis in Survivors

et al. 2004

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“…The hemorrage which occured in the 160 th day, can be attributed to the hypertension associated with cyclosporine, steroids and also the thrombotic propylaxis aspirin and LMWH. Martinez et al found that 24% of patients had evidence of cerebral hemorrhage, whereas 9% had evidence of infarcts, in an autopsy series [27].…”

Section: Clinical Features Of Odsmentioning

confidence: 97%

An Interesting Case of Osmotic Demyelination Syndrome, with two Cerebrovascular Accidents in a Post Liver Transplant Patient

Kanimozhi¹

2017

jmscr

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Though ODS is perceived to be a dreadful complication classically occurring after aggressive therapy for hyponatremia, it is important to recognise that osmotic demyelination can develop in patients with any levels of sodium, indicating the contribution of other factors [1] . Alcohol abuse, liver transplantation, malnutrition [2,3] are strong independent risk factors for the development of ODS. We present the events in a case of an Ethanol related Decompensated Liver Disease(DCLD), who developed ODS after liver transplantation, with normal sodium levels, who eventually suffered an embolic stroke later and a cerebral hemorrhage towards discharge.

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“…A méthylprednisolone bo lus is given for 5 days, usually starting with 100 mg/day, then tapered and switched to oral prednisone, 2.5-5 mg/day [2,10], Rejection, characterized by elevated transaminase, bilirubin, and canalicular levels, is treated by increasing the daily oral steroid dose and/or a sec ond 5-day intravenous steroid bolus [2]. Severe rejection, verified by liver biopsy, is treated with monoclonal anti-T lymphocyte antibodies (5-10 m g /k g /d a y ) for 7-10 days [3,12],…”

Section: Immunosuppressionmentioning

confidence: 99%

“…Improve ments in immunosuppressive regimens, such as the in troduction of ciclosporin and monoclonal antibodies, and refinements in surgical technique are largely re sponsible for prolonged survival (1,2]. Although clini cians and pathologists have focused their attention on the liver to explain the morbidity and mortality seen af ter transplantation, other organ systems can be greatly affected, especially the central nervous system (CNS) [3,4].…”

Section: Introductionmentioning

confidence: 99%

Neuropathology of Pediatric Liver Transplantation

Hall

Martinez

1989

Pediatr Neurosurg

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We reviewed the clinical histories and autopsy records of 35 pediatric patients (ranging in age from 9 months to 18 years) who underwent orthotopic liver transplantation using ciclosporin and corticosteroids for immunosuppression. At the time of death, 19 children (54%) had encephalopathy, 16 (46%) were lethargic or in coma, 10 (29%) had seizures, and 10 were normal. Neuropathological lesions were found on postmortem examination inall 35 patients. Vascular lesions such as infarction, ischemia, thrombosis, and hemorrhage were the most commonneuropathological findings (86%) followed by infectious processes (29%). Candida albicans (2 patients) and Aspergillusfumigatus (3 patients) were the only offending organisms identified, both causing meningoencephalitis. Alzheimer type II astrocytes, a characteristic feature of chronic liver disease, were the singlemost common autopsyfinding (69%). Central pontine myelinolysis was seen in 3 children and basilar artery thrombosis affected 1 child.Neurological complications and their subsequent neuropathology are a significant cause of morbidity and mortality after pediatric liver transplantation. Vascular insults, electrolyte abnormalities, and infections that involve thecentral nervous system are directly related to liver function and the immunosuppression necessary to maintain graftviability. Only with continued observation after surgery combined with rapid medical and surgical treatment can we hope to improve the prognosis following liver transplantation in the pediatric population.

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Neurologic Complications of Liver Transplantation

Cited by 67 publications

References 61 publications

New-Onset Seizures after Liver Transplantation: Clinical Implications and Prognosis in Survivors

New-Onset Seizures after Liver Transplantation: Clinical Implications and Prognosis in Survivors

An Interesting Case of Osmotic Demyelination Syndrome, with two Cerebrovascular Accidents in a Post Liver Transplant Patient

Neuropathology of Pediatric Liver Transplantation

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