Korean J Transplant.  2021 Dec;35(4):275-280. 10.4285/kjt.21.0021.

Careful neurologic examination and treatment for intracranial hemorrhage after liver transplantation in patients with alcoholic cirrhosis: case reports

• Noh B
• Lee N
• Lee JI
• Yoon M

• KMID: 2523679
• DOI: http://doi.org/10.4285/kjt.21.0021

Abstract

Intracranial hemorrhage (ICH) following liver transplantation is a potentially devastating complication. Although hypertension and thrombocytopenia are well-known risk factors for ICH in the general population, their roles in ICH after liver transplantation have not been well established. ICH occurred in two patients with alcoholic cirrhosis after deceased donor liver transplantation. A 38-year-old man presented with acute ICH in the right parietal lobe on day 16 after transplantation, with decreased level of consciousness and seizure. His mental status improved with immediate neurological treatment without surgery. In the second case, a 42-year-old woman had acute ICH in the left frontoparietal lobes on day 9 after transplantation, with generalized tonic-clonic seizures. Urgent cerebral decompression was performed. The patient’s neurological symptoms gradually recovered. In both cases, the blood platelet count was less than 50,000/mm 3 . Monitoring cerebral pressure for ICH is an invasive and challenging method, especially in patients with cirrhosis who have issues with hemostasis. Surgeons should be critically mindful of the risk of rapid neurological deterioration in patients with cirrhosis. Careful neurologic examination and immediate treatment to lower intracranial pressure for ICH after liver transplantation in patients with alcoholic cirrhosis are very important.

Keyword

Intracranial hemorrhage; Liver transplantation; Alcoholic cirrhosis; Case report

Figure

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  Fig. 1 Initial magnetic resonance imaging and interval computed tomography images of a 38-year-old man. (A, B) Acute intracranial hemorrhage (ICH) in the right parietal lobe on postoperative day 16. (C, D) Improvement in acute ICH in the right parietal lobe on postoperative month 6.

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  Fig. 2 Interval computed tomography images of a 42-year-old woman. (A) Acute intracranial hemorrhage (ICH) in the left front-parietal lobes on postoperative day (POD) 9. (B) After craniectomy with drainage for acute ICH in the left front-parietal lobes on POD 15. (C) Improvement in acute ICH after cranioplasty in the left front-parietal lobes on postoperative month 31.

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  Fig. 3 Serum liver chemistries and tacrolimus level during the transplantation period. The X axis represents various time points after transplantation when the serum liver chemistries and tacrolimus levels were measures (Y axis). Hyper bilirubinemia developed 4 months posttransplantation and improved 9 months postoperatively. AST, aspartate aminotransferase; ALT, alanine transferase.

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