Kim Minwoo, Kim Jae Hyun, Park Wonhyoung, Park Jung Cheol, Ahn Jae Sung, Kwun Byung Duk, Lee Sung-Gyu, Hwang Shin, Kim Moinay, Lee Seungjoo
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Mar 11;39(9):e88. doi: 10.3346/jkms.2024.39.e88.
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.
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.
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.
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.
与接受其他类型实体器官移植的个体相比，肝移植（LT）患者似乎更容易发生神经系统事件。本研究的目的是分析肝移植（LT）患者未破裂颅内动脉瘤（UIA）的患病率，并检查围手术期蛛网膜下腔出血（SAH）的发生情况。此外，本研究旨在系统地确定LT术后一年内SAH和出血性卒中（HS）的危险因素，并建立一个涉及LT患者不同临床特征的评分系统。
对2012年1月至2022年3月期间接受LT的患者进行分析。所有纳入患者在LT前6个月内均接受了神经血管成像检查。我们对UIA和SAH的患病率及影像学特征进行了分析。还回顾了可能对LT术后一年内HS产生影响的临床因素。
应用纳入和排除标准后，共有3487例患者纳入本研究。UIA的患病率为5.4%。LT术后一年内SAH和HS的发生率分别为0.5%和1.6%。我们基于多变量分析开发了一个评分系统，以预测LT术后1年内的HS。变量包括入院时精神状态差、UIA诊断、血清氨水平和终末期肝病模型（MELD）评分。我们的模型在开发队列（C指数，0.727；95%置信区间[CI]，0.635 - 0.820）和验证队列（C指数，0.719；95%CI，0.598 - 0.801）中显示出良好的区分度。
LT患者中UIA和SAH的发生率非常低。入院时精神状态差、UIA诊断、血清氨水平和MELD评分与LT术后一年内HS的风险显著相关。我们的评分系统在预测LT患者的HS方面显示出良好的区分度。
