Tom K Gallagher1,2,3, Kathryn A Thomas1, Daniela P Ladner1,3, Daniel Ganger1,4, Farzaneh A Sorond5, Shyam Prabhakaran5, Michael M Abecassis1,3, Jonathan P Fryer1,3, Eric M Liotta1,5. 1. Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL. 2. Division of Hepatobiliary and Transplant Surgery, Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland. 3. Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL. 4. Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL. 5. Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Abstract
BACKGROUND: Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. METHODS: We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. RESULTS: Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhage patients died during hospitalization. Fourteen (45%) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. CONCLUSIONS: Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.
BACKGROUND:Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. METHODS: We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. RESULTS: Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhagepatients died during hospitalization. Fourteen (45%) intracranial hemorrhagepatients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. CONCLUSIONS: Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.
Authors: Kevin T Huang; Wenya Linda Bi; Muhammad Abd-El-Barr; Sandra C Yan; Ian J Tafel; Ian F Dunn; William B Gormley Journal: Neurocrit Care Date: 2016-04 Impact factor: 3.210
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: A Gadano; A Hadengue; J J Widmann; F Vachiery; R Moreau; S Yang; T Soupison; P Sogni; C Degott; F Durand Journal: Hepatology Date: 1995-08 Impact factor: 17.425
Authors: Andrea Loggini; Victor J Del Brutto; Faten El Ammar; Zachary B Bulwa; Faddi Saleh Velez; Cedric McKoy; Raisa C Martinez; James Brorson; Fernando D Goldenberg; Agnieszka A Ardelt Journal: Neurocrit Care Date: 2020-12 Impact factor: 3.210