The neuropathology of orthotopic liver transplantation: an autopsy series of 16 patients

Arch Pathol Lab Med. 1998 Aug;122(8):726-31.

Abstract

Objective: To examine the neuropathologic findings seen in the setting of orthotopic liver transplantation (OLT) and to asses the role, if any, that the neuropathology had in the patient's death.

Design: Retrospective autopsy series of 16 patients.

Setting: Tertiary referral center with a high volume of liver transplantation.

Patients: Sixteen OLT patients who died and in whom a complete autopsy, including examination of the brain and spinal cord, was performed.

Results: Sixteen patients, including 13 women and 3 men, comprised the study group. Patients ranged in age from 25 to 64 years (mean 44.8 years). Postoperative OLT survival ranged from 1 to 1962 days (mean 236 days). Reasons for the initial OLT included hepatitis (n = 6), fulminant hepatic failure (n = 4), cryptogenic cirrhosis (n = 2), methotrexate toxicity (n = 1), postoperative complication (n = 1), primary biliary cirrhosis (n = 1), and hepatocellular carcinoma (n = 1). Autopsies in 13 (81%) patients showed neuropathology; in only 2 patients, however, was the primary cause of death attributable to these findings. The most common neuropathology was related to anoxia or infarction, specifically, ischemia or focal neuronal necrosis (n = 9), infarction (n = 4), and diffuse anoxic encephalopathy (n = 3). Other central nervous system findings included infection with Aspergillus, Candida, and Toxoplasma (n = 3). The most common cause of death was infection-related in 8 patients. One patient died of pulmonary hypertension, 1 of acute rejection, and 1 of possible hyperacute rejection. Two patients died directly as a consequence of neuropathology findings; one had massive central edema with herniation, and the other had a large intracerebral hemorrhage with herniation. The exact cause of death was unclear in 3 patients.

Conclusions: The most common neuropathology findings in this series were related to ischemia and infarction. Neuropathology findings are a significant cause of morbidity, but were only rarely the main cause of death (n = 2) in the OLT patients in this study.

MeSH terms

  • Adult
  • Autopsy
  • Brain / pathology*
  • Brain Ischemia / pathology
  • Central Nervous System Diseases / pathology*
  • Cerebral Hemorrhage / pathology
  • Cerebral Infarction / pathology
  • Female
  • Humans
  • Liver Transplantation / pathology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Cord / pathology*