Blanco R, De Girolami U, Jenkins R L, Khettry U
Department of Pathology, New England Deaconess Hospital, Boston, MA, USA.
Clin Neuropathol. 1995 Mar-Apr;14(2):109-17.
We reviewed retrospectively the clinical records, autopsy protocols and central nervous system tissue sections of 50 patients who underwent orthotopic liver transplantation for end-stage liver disease between 12/83 and 8/93. The postoperative survival period ranged from hours (6), weeks (17), months (17), to years (10). All patients received immunosuppressive drugs from the immediate postoperative period to the time of their death (cyclosporine, steroids; occasionally azathioprine, OKT3, FK506). Nineteen patients had neurological manifestations (hepatic encephalopathy) prior to surgery. Post-transplant neurologic signs and symptoms included: hepatic encephalopathy/altered mental status (11), focal or generalized seizures (9) and stroke (2). In the majority of cases (37) the cause of death was septicemia and/or bleeding diathesis. The neuropathologic findings present in 36 patients could be classified into 3 distinct categories: metabolic disorders: hepatic/anoxic encephalopathy, central pontine myelinolysis (15); cerebrovascular disease: subarachnoid and/or intracerebral hemorrhage, bland or hemorrhagic infarction (23); and infection: bacterial meningitis/cerebritis, multifocal fungal microabscesses, presumptive viral meningitis/encephalomyelitis (10). In conclusion, 72% of 50 patients who came to autopsy after liver transplantation were found to have neuropathologic abnormalities; these abnormalities were predominantly infections and vascular diseases.
我们回顾性分析了1983年12月至1993年8月期间因终末期肝病接受原位肝移植的50例患者的临床记录、尸检报告和中枢神经系统组织切片。术后存活时间从数小时（6例）、数周（17例）、数月（17例）至数年（10例）不等。所有患者从术后即刻至死亡时均接受免疫抑制药物治疗（环孢素、类固醇；偶尔使用硫唑嘌呤、OKT3、FK506）。19例患者在手术前有神经学表现（肝性脑病）。移植后神经体征和症状包括：肝性脑病/精神状态改变（11例）、局灶性或全身性癫痫发作（9例）和中风（2例）。在大多数病例（37例）中，死亡原因是败血症和/或出血倾向。36例患者的神经病理学发现可分为3个不同类别：代谢紊乱：肝性/缺氧性脑病、中枢性桥脑髓鞘溶解（15例）；脑血管疾病：蛛网膜下腔和/或脑内出血、非出血性或出血性梗死（23例）；以及感染：细菌性脑膜炎/脑炎、多灶性真菌微脓肿、疑似病毒性脑膜炎/脑脊髓炎（10例）。总之，50例肝移植后接受尸检的患者中有72%被发现存在神经病理学异常；这些异常主要是感染和血管疾病。
