J Korean Med Sci.  2024 Mar;39(9):e88. 10.3346/jkms.2024.39.e88.

Risk of Cerebral Aneurysm Rupture After Liver Transplantation: Development and Validation of a Hemorrhagic Stroke Scoring Model

• Kim M
• Kim JH
• Park W
• Park JC
• Ahn JS
• Kwun BD
• Lee SG
• Hwang S
• Kim M
• Lee S

• KMID: 2553337
• DOI: http://doi.org/10.3346/jkms.2024.39.e88

Abstract

Background
Liver transplantation (LT) patients appear to be more prone to neurological events compared to individuals undergoing other types of solid-organ transplantation. The aims of the present study were to analyze the prevalence of unruptured intracranial aneurysms (UIAs) in patients undergoing liver transplantation (LT) and to examine the perioperative occurrence of subarachnoid hemorrhage (SAH). Also, it intended to systematically identify the risk factors of SAH and hemorrhagic stroke (HS) within a year after LT and to develop a scoring system which involves distinct clinical features of LT patients.
Methods
Patients who underwent LT from January 2012 to March 2022 were analyzed. All included patients underwent neurovascular imaging within 6 months before LT. We conducted an analysis of prevalence and radiological features of UIA and SAH. The clinical factors that may have an impact on HS within one year of LT were also reviewed.
Results
Total of 3,487 patients were enrolled in our study after applying inclusion and exclusion criteria. The prevalence of UIA was 5.4%. The incidence of SAH and HS within one year following LT was 0.5% and 1.6%, respectively. We developed a scoring system based on multivariable analysis to predict the HS within 1-year after LT. The variables were a poor admission mental status, the diagnosis of UIA, serum ammonia levels, and Model for End-stage Liver Disease (MELD) scores. Our model showed good discrimination among the development (C index, 0.727; 95% confidence interval [CI], 0.635–0.820) and validation (C index, 0.719; 95% CI, 0.598–0.801) cohorts.
Conclusion
The incidence of UIA and SAH was very low in LT patients. A poor admission mental status, diagnosis of UIA, serum ammonia levels, and MELD scores were significantly associated with the risk of HS within one year after LT. Our scoring system showed a good discrimination to predict the HS in LT patients.

Keyword

Aneurysm; Intracerebral Hemorrhage; Stroke; Subarachnoid Hemorrhage; Liver Transplantation; Scoring System

Figure

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  Fig. 1 Enrollment and follow-up for study patients.LT = liver transplantation, ICH = intracerebral hemorrhage, UIA = unruptured intracranial aneurysm, LC = liver cirrhosis.

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  Fig. 2 Area under the receiver-operating characteristic curve of prediction for the scoring system in the development and validation cohorts.

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