NEUROPATHOLOGY OF LIVER-TRANSPLANTATION

We reviewed retrospectively the clinical records, autopsy protocols an d central nervous system tissue sections of 50 patients who underwent orthotopic liver transplantation for end-stage liver disease between 1 2/83 and 8/93. The postoperative survival period ranged from hours (6) , weeks (17), months (17), to years (10). All patients received immuno suppressive drugs from the immediate postoperative period to the time of their death (cyclosporine, steroids; occasionally azathioprine, OKT 3, 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 classif ied into 3 distinct categories: metabolic disorders: hepatic/anoxic en cephalopathy, central pontine myelinolysis (15); cerebrovascular disea se: subarachnoid and/or intracerebral hemorrhage, bland or hemorrhagic infarction (23); and infection: bacterial meningitis/cerebritis, mult ifocal fungal microabscesses, presumptive viral meningitis/encephalomy elitis (10). In conclusion, 72% of 50 patients who came to autopsy aft er liver transplantation were found to have neuropathologic abnormalit ies; these abnormalities were predominantly infections and vascular di seases.