The number of orthotopic liver transplantation performed each year is increasing due to increased safety and logistic facilities. Therefore, the importance of reducing adverse events is progressively growing.
To review present knowledge on the neurological complications of orthotopic liver transplantation.
The epidemiology, the clinical features and the pathophysiology of the neurological complications of orthotopic liver transplants, resulting from a systematic review of the literature in the last 25 years, are summarized.
The review highlights that a relevant variety of neurological adverse events can occur in patients undergoing orthotopic liver transplantation. The knowledge of neurological complications of orthotopic liver transplantation is important for transplantation teams to reduce their prevalence and improve their management. In addition, the likelihood of neurological adverse effects provides evidence for the need of a careful cognitive and neurological work up of patients in the orthotopic liver transplantation waiting list, in order to recognize and interpret neurological dysfunction occurring after orthotopic liver transplantation.
"Cerebral thromboembolism could also induced by liver transplantation surgery due to peri-operative detachment of arterial emboli from carotid or intracranial arteries or paradoxical emboli of thrombotic material from deep leg . Thus, we could differentiate our case from those occurred after liver transplantation by prominent air embolic signal (Fig. 2). "
[Show abstract][Hide abstract] ABSTRACT: Endovascular repair with covered stents has been widely used to treat subclavian and axillary artery injuries and has produced promising early results. The possibility of a thromboembolism occurring in cerebral arteries during an endovascular procedure should be a cause for concern. In the case of endovascular management of arterial traumas, a prompt and sufficient period for check-up of the patient's neurological signs is needed, even if it requires postponing elective intervention for the patient's safety. We report a rare case of liver transplantation immediately after endovascular repair of an iatrogenic subclavian arterial injury to describe the risk of continuing planned surgery without neurologic assessment.
Korean journal of anesthesiology 08/2014; 67(2):139-43. DOI:10.4097/kjae.2014.67.2.139
"Signed informed consent was obtained from all participants. The diagnosis of MHE was based on spectral EEG features and on psychometric hepatic encephalopathy score (PHES; Amodio et al. 2007; Weissenborn et al. 2001). Cirrhotic patients were qualified as having MHE if either PHES or EEG were abnormal (Ferenci et al. 2002). "
[Show abstract][Hide abstract] ABSTRACT: Recent evidence reveals that inter- and intra-individual variability significantly affects cognitive performance in a number of neuropsychological pathologies. We applied a flexible family of statistical models to elucidate the contribution of inter- and intra-individual variables on cognitive functioning in healthy volunteers and patients at risk for hepatic encephalopathy (HE). Sixty-five volunteers (32 patients with cirrhosis and 33 healthy volunteers) were assessed by means of the Inhibitory Control Task (ICT). A Generalized Additive Model for Location, Scale and Shape (GAMLSS) was fitted for jointly modeling the mean and the intra-variability of Reaction Times (RTs) as a function of socio-demographic and task related covariates. Furthermore, a Generalized Linear Mixed Model (GLMM) was fitted for modeling accuracy. When controlling for the covariates, patients without minimal hepatic encephalopathy (MHE) did not differ from patients with MHE in the low-demanding condition, both in terms of RTs and accuracy. Moreover, they showed a significant decline in accuracy compared to the control group. Compared to patients with MHE, patients without MHE showed faster RTs and higher accuracy only in the high-demanding condition. The results revealed that the application of GAMLSS and GLMM models are able to capture subtle cognitive alterations, previously not detected, in patients' subclinical pathologies.
"Some clues for a progress in the understanding of this syndrome regard the changes occurring into the brain due to ammonia (Butterworth 2003; Haussinger 2006; Norenberg et al. 2007) and body ammonia trafficking (Olde Damink et al. 2002a, b; Romero-Gomez et al. 2006). In addition, new features of brain-liver interaction are appearing on the horizon and are worthy of consideration: a detrimental influence of HCV virus on cognitive function and wellbeing (Forton et al. 2001), either related to the virus per se or to systemic or brain inflammatory response; the influence of liver transplantation and immunosuppressive agents on the brain (Amodio et al. 2007); the renewed interest for nutrition, microelements deficiency, notably—but not only—thiamine; and the consequences of alcohol misuse (Butterworth 1995; Kalaitzakis et al. 2007). Treatment for hepatic encephalopathy is still based, somewhat empirically, on our concepts of the pathogenesis of the syndrome and so primarily on methods to Fig. 1 The Morgagni's Book of Medicine where liver cirrhosis and a possible case of HE are described. "
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