Cerebral Diseases in Liver Transplant Recipients: Systematic Review of Clinical Evidence.

Paula Dudek,Rafael Badenes,Federico Bilotta,Paweł Andruszkiewicz,Remigiusz Gelo

doi:10.3390/jcm11040979

Abstract

This systematic review presents clinical evidence on early and long-term cerebral diseases in liver transplant recipients. The literature search led to the retrieval of 12 relevant studies. Early postoperative cerebral complications include intracranial hemorrhage associated with a coexisting coagulopathy, perioperative hypertension, and higher MELD scores and is more frequent in critically ill recipients; central pontine and extrapontine myelinolysis are associated with notable perioperative changes in the plasma Na+ concentration and massive transfusion. Long-term follow-up cerebral complications include focal brain lesions, cerebrovascular diseases, and posterior reversible encephalopathy; there is no proven relationship between the toxicity immunosuppressive drugs and cerebral complications. This SR confirms a very low incidence of opportunistic cerebral infections.

Highlights

Cerebral diseases—including cerebral hemorrhage, cerebrovascular, encephalopathies, etc.—after a liver transplant (LT) can complicate the early postoperative period, before hospital discharge, or occur can during long-term follow-up and are reported in 15–71% of patients [1,2,3,4,5]
During long-term management, LT recipients are exposed to the adverse effects of immunosuppression, which are related to an increased risk of cerebrovascular events in these patient populations [12]
Patients who have undergone liver transplantation are at an increased risk for early and long-term cerebral complications; a systematic review (SR) that addresses related clinical evidence is lacking

Summary

Introduction

Cerebral diseases—including cerebral hemorrhage, cerebrovascular, encephalopathies, etc.—after a liver transplant (LT) can complicate the early postoperative period, before hospital discharge, or occur can during long-term follow-up and are reported in 15–71% of patients [1,2,3,4,5]. Something of note in liver transplant patients is that neurological events are more frequent than after other types of solid-organ transplantation [6] The etiology of this is multifactorial and is partially related to the fragile preoperative clinical condition of LT recipients (malnutrition, coagulopathy, multi-organ dysfunction, pre-LT encephalopathy, etc.) and to the complexity of the surgical procedure (major intraoperative hemorrhage with hemodynamic instability, major fluid shifts, etc.) and of the postoperative course [7,8]. Patients who have undergone liver transplantation are at an increased risk for early and long-term cerebral complications; a systematic review (SR) that addresses related clinical evidence is lacking. During long-term management, LT recipients are exposed to the adverse effects of immunosuppression (diabetes, hypertension, hypercholesterolemia, impairment of renal function), which are related to an increased risk of cerebrovascular events in these patient populations [12]

Methods

Results

Discussion

Conclusion