Intracranial pressure during liver transplantation for fulminant hepatic failure

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.