Postoperative hemorrhagic stroke (HS) is a rare yet devastating complication after liver transplantation (LT). Unruptured intracranial aneurysm (UIA) may contribute to HS; however, related data are limited. We investigated UIA prevalence and aneurysmal subarachnoid hemorrhage (SAH) and HS incidence post-LT.
Previous studies have reported the incidence of post-transplantation stroke, varying from 1.1 to 8.0% (5, 6, 13, 23, 24) in KT recipients and 1.8 to 4% (8–10) in LT recipients. Our transplantation recipients presented with a relatively lower incidence of 1.3 and 1.8%, respectively.
Overall, infections are the most frequent cause of mortality in males and females, though they are significantly higher in females. In our cohort, the main causes of mortality within the first year after transplantation were infections and surgical complications in both sexes.
Major neurologic complications include alterations of consciousness, seizures, cerebrovascular complications and central nervous system (CNS) infections, similarly as with other solid organ transplants, and also central pontine myelinolysis (CPM) which is characteristic for liver transplantation.
Graft failure
It's one of the most serious complications of a liver transplant and occurs in around 1 in every 10 people. The most common cause is a disruption to the blood supply to the transplanted liver, caused by blood clots (thrombosis).
Liver failure
There is a risk that your remaining liver doesn't work after your operation.
If rejection occurs, you may experience some mild symptoms, although some patients may continue to feel fine for a while. The most common early symptoms include a fever greater than 100° F or 38° C, increased liver function tests, yellowing of the eyes or skin, and fatigue.
Cognitive impairment following LT is frequent, referred to as postliver transplant encephalopathy (PLTE). LT removes the underlying chronic liver disease, and until recently hepatic encephalopathy (HE) was assumed to be fully reversible after LT.
Infections continue to be one of the main complications that can contribute to the patient's death. More than half of transplanted patients have at least one infections complication and an infection is responsible of more than half of the deaths in liver transplant recipients.
Bleeding, stenosis and thrombosis can arise at any of the vascular anastomoses, as well as aneurysms at the arterial anastomosis and exceptionally on the portal vein[6,7], with an overall reported incidence of 7.2%-15% in adults (mainly arterial 5%-10%, following by portal 1%-3% and caval < 2%) (Table 1)[5,8-10].
Liver transplant can have excellent outcomes. Recipients have been known to live a normal life over 30 years after the operation.
Surgical complications after liver transplantation are most frequent within the first 90 days but do occur late after surgery. Common late complications include incisional hernias as well as biliary strictures, although rarer complications (HAT and PVT) can result in substantial morbidity.
Stroke and liver cirrhosis are two leading causes of death worldwide [1]. Patients with liver cirrhosis often have coagulopathy, hypoperfusion, cardiac diseases, diabetes, and dyslipidemia, which are associated with the development of stroke. Recent evidence also suggests a higher risk of stroke in liver cirrhosis.
Thrombosis of the hepatic artery (HAT) can occur both early and/or months after the transplantation. The reported incidence of HAT ranges between 2.5% and 6% in adults and 15%-20% in children[18].
Acute ischaemic stroke is associated with a high risk of non-neurological complications, which include respiratory failure, cardiovascular dysfunction, kidney and liver injury, and altered immune and endocrine function.
Organ rejection is a constant threat. Keeping the immune system from attacking your transplanted organ requires constant vigilance. So, it's likely that your transplant team will make adjustments to your anti-rejection drug regimen.
In general, about 75% of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 75 will live for five years and 25 will die within five years.
Different types of rejection need different treatments. The risk of rejection is commonest in the first 6 months after liver transplant (early). Beyond this, as long as patients remember to take their prescribed immune suppression, at the correct dosage, late rejection is much less common.
For many people, the transplant process causes them to have a lot of emotions. This is normal. There is no right way to feel after a transplant. You may even have feelings that seem to conflict (like feeling grateful and angry).
Specifically in transplant patients, delirium may be caused by metabolic disturbances, infections, organ failure leading to hepatic or uremic encephalopathy, or neurotoxic side effects from immunosuppression medications such as calcineurin inhibitors or high-dose steroids.
It occurs in people who suffer from advanced liver disease, liver failure, or other major liver problem. When the liver does not filter the blood properly, toxins build up in the bloodstream. These toxins can affect brain functioning, even causing permanent brain injuries.
After a big operation, you may wake up in the intensive care unit or a high dependency unit. You usually move back to the ward within a day or so. This information is for people who are having part of their liver removed. Your doctor might call this a liver resection or a lobectomy.