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Cerebrovascular complications after orthotopic liver transplantation

A clinicopathologic study

Department of Neurology (Drs. Estol and Pessin), Tufts University School of Medicine and the New England Medical Center, Boston, MA; and the Pathology Department, Neuropathology Division (Dr. Martinez), Presbyterian University Hospital, University of Pittsburgh, Pittsburgh, PA.

We analyzed 55 autopsy cases in 1,357 patients undergoing orthotopic liver transplantation at the University of Pittsburgh and found that 13 (23.6%) patients had intracranial bleeding, and five (9%) had infarcts. Eight patients had bleeding localized to one intracranial compartment: intracerebral hemorrhage (three patients); subarachnoid hemorrhage (three patients); and subdural hematoma (two patients). Five patients had combinations of multiple sites of bleeding: three with subarachnoid hemorrhage-intracerebral hemorrhage, one with subarachnoid hemorrhage-intracerebral hemorrhage-subdural hematoma, and one with subdural hematoma-intracerebral hemorrhage. Coexistent CNS infections (fungal or bacterial) were associated with hemorrhagic infarcts and intracerebral hemorrhage in four patients. Cerebral embolism and hemorrhagic infarction from bacterial endocarditis occurred in one patient. Five patients died of intracranial bleeding. Severe coagulopathy was the major cause of intracranial bleeding and was associated with systemic bleeding in 12 patients. Significant systemic or metabolic complications were present in all patients and masked the focal signs of the intracranial process in more than one half.

Address correspondence and reprint requests to Dr. Conrado Estol, Department of Neurology. New England Medical Center, 750 Washington Street, Boston, MA 02111.

Received September 24, 1990. Accepted for publication in final form November 26, 1990.

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