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Neuropathologic findings after liver transplantation
J A Ferreiro1, M A Robert, J Townsend
1Department of Pathology, UCLA Medical Center 90024-1732.
Abstract:
Neuropathologic findings are described in 37 patients autopsied after one or more orthotopic liver transplants. Gross or microscopic lesions were observed in almost all patients, including anoxic-ischemic change, hemorrhages and/or infarcts, and opportunistic infections by fungi (most commonly Aspergillus) and rarely viruses (cytomegalovirus). Central pontine and extra-pontine myelinolysis was commonly observed, and appeared to result from severe multifactorial metabolic abnormalities in the perioperative period. Low-grade (microglial nodule) encephalitis without an obvious pathogen was often encountered. Common clinical neurologic abnormalities included encephalopathy, seizures (myoclonic, focal or generalized), obtundation and coma. These were found more commonly than focal findings, but clinical features in a given patient were not uniformly predictive of underlying neuropathologic change.
Insights
Neuropathologic changes are common after liver transplantation, with metabolic issues causing myelinolysis and opportunistic infections like Aspergillus being frequent. Clinical symptoms often don't predict specific brain abnormalities found post-mortem.
Area of Science:
- Neuropathology
- Transplant Medicine
- Neuroscience
Background:
- Orthotopic liver transplantation is a life-saving procedure.
- Patients undergoing liver transplants are susceptible to various neurological complications.
- Understanding post-transplant neuropathology is crucial for patient care.
Purpose of the Study:
- To describe the neuropathologic findings in patients following orthotopic liver transplantation.
- To correlate clinical neurologic abnormalities with autopsy findings.
- To identify common neurological complications and their potential causes.
Main Methods:
- Autopsy examination of 37 patients who underwent orthotopic liver transplantation.
- Gross and microscopic neuropathologic analysis.
- Review of clinical neurologic data.
Main Results:
- Almost all patients exhibited neuropathologic lesions.
- Common findings included anoxic-ischemic changes, hemorrhages, infarcts, and opportunistic infections (Aspergillus, cytomegalovirus).
- Central pontine and extra-pontine myelinolysis were frequent, linked to metabolic derangements; low-grade encephalitis was also common.
- Clinical encephalopathy and seizures were more prevalent than focal deficits, but not always predictive of specific neuropathology.
Conclusions:
- Neuropathologic abnormalities are highly prevalent after liver transplantation.
- Metabolic disturbances and opportunistic infections are significant contributors to neurological damage.
- Clinical presentation may not reliably predict the specific neuropathologic changes observed.