Incidence, Management, and Outcomes of Intracranial Hemorrhage After Heart, Lung, and Liver Transplantation

Intracranial hemorrhage (ICH) after organ transplantation presents significant challenges in clinical management. We investigated the incidence, risk factors, and long-term outcomes of ICH after heart, liver, or lung transplantation.

We retrospectively reviewed patients who experienced ICH within 3 months post-transplantation between April 2017 and June 2023 at our institution. Data were curated from review of medical records and radiographic data. Functional status was assessed using the modified Rankin score (mRS) and Utility Weighted mRS (UWmRS) at 90 days and 1-year posthemorrhage. Statistical analyses included survival analysis, logistic and linear regressions.

Among 2223 transplant recipients, 28 (1.3%) experienced ICH within 3 months post-transplant (mean age 56, 39% female patients). The primary hemorrhage types were intraparenchymal (43%), subdural (28.5%), and subarachnoid (28.5%). The transplant types were heart (54%), liver (39%), and lung (7%). The median preadmission mRS was 2. At 90 days post-ICH, the median mRS was 4, with an average UWmRS of 0.42; at 1 year, the median mRS was 5, and the UWmRS dropped to 0.11. Mortality was 39% at 90 days and 1-year post-ICH. Rehemorrhage occurred in 14% of patients. Higher ICH score was associated with significantly higher mRS scores at 90 days post-ICH indicating worse outcomes (adjusted estimate = 3.1, 95% CI 0.3-8.5-0.38, P = .031).

ICH within 3 months of organ transplantation is associated with high morbidity and mortality. Early identification of high-risk patients and tailored management strategies are crucial for improving outcomes in this population.