Pujol A, Graus F, Rimola A, Beltrán J, Garcia-Valdecasas J C, Navasa M, Grande L, Galofré J, Visa J, Rodés J
Service of Neurology, Hospital Clínic i Provincial, University of Barcelona, Spain.
Neurology. 1994 Jul;44(7):1226-30. doi: 10.1212/wnl.44.7.1226.
We prospectively evaluated 84 consecutive adult patients with chronic liver disease before and after liver transplantation to define the type and frequency of post-transplant neurologic complications, and to assess possible pretransplant and operative variables associated with in-hospital CNS complications. There were 25 patients (30%) who presented 23 neurologic complications of the central and six of the peripheral nervous system. Seventy-five percent of the complications occurred in the first month post-transplant. The most frequent CNS complications included anoxic (six patients) and septic (five) encephalopathy, as well as brain hemorrhage (five). Patients who presented CNS complications had a higher mortality rate than those who did not (55% versus 17%, p = 0.002). Multiple logistic regression analysis showed abnormal pretransplant neurologic examination suggestive of chronic hepatic encephalopathy (p = 0.007) and noncholestatic liver disease (p = 0.012) to be independently associated with in-hospital CNS complications. These data indicate that CNS neurologic complications following liver transplant are common in patients with noncholestatic liver disease and are associated with increased mortality. The pretransplant neurologic examination is an important predictor of CNS complications that occur in the immediate post-transplant period.
我们对84例连续的成年慢性肝病患者在肝移植前后进行了前瞻性评估，以确定移植后神经并发症的类型和发生率，并评估与住院期间中枢神经系统并发症相关的可能的移植前和手术变量。有25例患者（30%）出现了23例中枢神经系统和6例周围神经系统的神经并发症。75%的并发症发生在移植后的第一个月。最常见的中枢神经系统并发症包括缺氧性脑病（6例）和感染性脑病（5例）以及脑出血（5例）。出现中枢神经系统并发症的患者死亡率高于未出现并发症的患者（55%对17%，p = 0.002）。多因素logistic回归分析显示，移植前提示慢性肝性脑病的神经检查异常（p = 0.007）和非胆汁淤积性肝病（p = 0.012）与住院期间中枢神经系统并发症独立相关。这些数据表明，肝移植后中枢神经系统神经并发症在非胆汁淤积性肝病患者中很常见，并且与死亡率增加相关。移植前神经检查是移植后即刻发生的中枢神经系统并发症的重要预测指标。
