Central Nervous System Complications After Liver Transplantation: Common but Mostly Transient Phenomena
Central Nervous System Complications After Liver Transplantation: Common but Mostly Transient Phenomena
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DOI：
10.1002/lt.24035
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发表时间：
2015-02-01
影响因子：
4.6
通讯作者：
Tryc, Anita Blanka
中科院分区：
文献类型：
--
作者：
Bernhardt, Martina;Pflugrad, Henning;Tryc, Anita Blanka
尽管原位肝移植术后中枢神经系统并发症（CNSC）很常见，但仍缺乏标准化的前瞻性研究。这项前瞻性研究旨在确定CNSC的发病率，描述其临床表现，并建立预测因素。纳入了2008年12月至2011年6月在汉诺威医学院接受奥尔特的136例成人患者。在奥尔特后住院期间，由神经科医生每周进行一次检查。收集患者数据、供体数据以及手术和术后变量。肝奥尔特后出现脑功能障碍的患者进行诊断性检查，包括脑成像，必要时进行脑脊液分析。有中枢神经系统（CNS）症状但影像学和脑脊液结果阴性的患者以及脑桥髓鞘溶解或可逆性后部脑病综合征患者被置于代谢毒性CNSC组，而卒中、颅内出血或CNS感染患者被置于非代谢性CNSC组。多元回归分析用于确定代谢毒性CNSC发展的独立风险因素。在排除了两名在奥尔特后没有恢复意识而死亡的患者后，44名（32.8%）患者发生了CNSC：其中37名（27.6%）患者患有代谢毒性CNSC，7名（5.2%）患者患有非代谢CNSC。慢性加急性肝功能衰竭、后续手术次数和原发性硬化性胆管炎被确定为代谢毒性CNSC发展的独立预测因子。代谢毒性CNSC与住院时间延长相关，非代谢性CNSC与死亡率升高相关。总之，CNSC是奥尔特后常见的相关并发症。奥尔特后的患者，特别是有危险因素的患者，应该接受定期的标准化神经系统检查，以便早期发现这些并发症。肝移植21：224-232，2015. (c)2014年AASLD。
Although central nervous system complications (CNSCs) are common after orthotopic liver transplantation (OLT), standardized prospective studies are still lacking. This prospective study was aimed at determining the incidence of CNSCs, describing their clinical presentations, and establishing predicting factors. One hundred thirty-six adult patients who underwent OLT at Hannover Medical School between December 2008 and June 2011 were included. Weekly examinations were performed by a neurologist during the hospital stay after OLT. Patient data, donor data, and operative and postoperative variables were collected. Patients with cerebral dysfunction after OLT underwent a diagnostic work-up, which included brain imaging and, if necessary, cerebrospinal fluid analysis. Patients with central nervous system (CNS) symptoms but negative imaging and cerebrospinal fluid results and patients with pontine myelinolysis or posterior reversible encephalopathy syndrome were placed in a metabolic-toxic CNSC group, and patients with strokes, intracranial hemorrhaging, or CNS infections were placed in a nonmetabolic CNSC group. Multiple regression analysis was used to identify independent risk factors for the development of metabolic-toxic CNSCs. After excluding two patients that died after OLT without regaining consciousness, forty-four (32.8%) patients developed CNSCs: 37 of these patients (27.6%) had metabolic-toxic CNSCs, and 7 (5.2%) had nonmetabolic CNSCs. Acute-on-chronic liver failure, the number of subsequent surgeries, and primary sclerosing cholangitis were identified as independent predictors for the development of metabolic-toxic CNSCs. Metabolic-toxic CNSCs were associated with prolonged hospital stays, and nonmetabolic CNSCs were associated with higher mortality. In conclusion, CNSCs are common and relevant complications after OLT. Patients after OLT, especially with risk factors, should undergo a regular standardized neurological examination that would allow early detection of these complications. Liver Transpl 21:224-232, 2015. (c) 2014 AASLD.