During orthotopic liver transplantation (OLT) for fulminant hepatic failure
(FHF), some patients develop cerebral injury secondary to intracranial hyp
ertension. We monitored intracranial pressure (ICP) and cerebral perfusion
pressure (CPP) before and during OLT in 12 FHF patients undergoing transpla
ntation. All four patients who had normal ICP preoperatively maintained nor
mal ICP/CPP throughout OLT. During OLT, four of the eight patients with pre
transplant intracranial hypertension had six episodes of ICP increase. Thes
e episodes of intracranial hypertension occurred during failing liver disse
ction (n=3) and graft reperfusion (n=3). At the end of the anhepatic phase,
the ICP was lower than the preoperative ICP in all patients, and was below
15 mmHg in all but one patient. These data suggest that in FHF patients wh
o develop intracranial hypertension before OLT, dissection of the native li
ver and graft reperfusion are associated with a risk of brain injury result
ing from intracranial hypertension and cerebral hypertension.