Abstract
Background: Cardiovascular morbidity has been cited as a prominent cause of post-operative orthotopic liver transplantation (post-OLT) complications, yet the role of ischemic stroke during this period remains poorly defined. We examined the incidence of post-OLT ischemic stroke, associated risk factors, etiology and neuroimaging features in an extensive single center database. Methods: All consecutive adult patients undergoing OLT from January 1, 2002 to December 15, 2013 at a single center were analyzed for neurological complications, characterizing post-operative stroke by neurology consultation and CT/MRI. Neurological history, examination, features of atrial fibrillation, concomitant infection, relevant laboratory parameters, and infarct patterns were reviewed in detail. Results: Of the 2,035 OLT cases analyzed, including 190 cases where neurology consultation was triggered, post-OLT ischemic stroke was identified in 20 patients (0.98%). Patients with ischemic stroke were significantly more likely to be older (64.4 vs. 53.6 years, p<0.001), have pre-existing coronary artery disease (21.4% vs. 5.6%, p=0.011), higher pre-transplant MELD scores (34 vs 27.7, p=0.018), and greater post-transplant infectious complications both within (45% vs 22.6%, p=0.017) and beyond (65% vs. 24.4%, p<0.001) 30 days post-OLT, and longer post-OLT length of hospitalization (53.2 vs 32.5 days, p=0.033). Comparing patients with and without post-OLT ischemic stroke, there were no significant differences in the incidence of preoperative (4.1% vs 5.0%, p=0.846) or postoperative (6.5% vs 10%, p=0.530) atrial fibrillation. Ischemic stroke was characterized with MRI in 19/20 (95%) and only CT in 1/20 (5%). Scattered, cortical lesions of probable embolic etiology were noted in 12/20 (60%) with only 3/20 (15%) proximal arterial territory lesions. Conclusions: Post-OLT ischemic stroke was relatively uncommon in this largest single center series of 2035 consecutive OLTs. Further insight on etiology of these complications may help to further reduce morbidity.
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