Spontaneous Intracranial Hemorrhage in Liver Failure: A Case-Based Approach to Transplant Candidacy and Care

Intracranial hemorrhage in patients with acute or chronic liver disease is a life-threatening complication with repercussions on both liver transplantation candidacy and perioperative transplant management. This case series and review of the literature details the perioperative management and outcomes of three patients who experienced spontaneous intracranial hemorrhage and subsequently underwent liver transplantation. These cases highlight the challenges encountered in such complex scenarios, emphasizing the critical need for individualized assessments, tailored management strategies, and a multidisciplinary approach to maximize patient outcomes. Moreover, these cases underscore how evolving neurocritical care practice, advances in hemostatic therapies, and improved coordination between transplant and neurology teams can expand access to transplantation. Collectively, these observations contribute to a growing evidence base, supporting nuanced decision-making in situations traditionally considered prohibitive for transplant surgery.