The neuropathology of orthotopic liver transplantation: an autopsy series of 16 patients.
OBJECTIVE
To examine the neuropathologic findings seen in the setting of orthotopic liver transplantation (OLT) and to asses the role, if any, that the neuropathology had in the patient's death.


METHODS
Retrospective autopsy series of 16 patients.


METHODS
Tertiary referral center with a high volume of liver transplantation.


METHODS
Sixteen OLT patients who died and in whom a complete autopsy, including examination of the brain and spinal cord, was performed.


RESULTS
Sixteen patients, including 13 women and 3 men, comprised the study group. Patients ranged in age from 25 to 64 years (mean 44.8 years). Postoperative OLT survival ranged from 1 to 1962 days (mean 236 days). Reasons for the initial OLT included hepatitis (n = 6), fulminant hepatic failure (n = 4), cryptogenic cirrhosis (n = 2), methotrexate toxicity (n = 1), postoperative complication (n = 1), primary biliary cirrhosis (n = 1), and hepatocellular carcinoma (n = 1). Autopsies in 13 (81%) patients showed neuropathology; in only 2 patients, however, was the primary cause of death attributable to these findings. The most common neuropathology was related to anoxia or infarction, specifically, ischemia or focal neuronal necrosis (n = 9), infarction (n = 4), and diffuse anoxic encephalopathy (n = 3). Other central nervous system findings included infection with Aspergillus, Candida, and Toxoplasma (n = 3). The most common cause of death was infection-related in 8 patients. One patient died of pulmonary hypertension, 1 of acute rejection, and 1 of possible hyperacute rejection. Two patients died directly as a consequence of neuropathology findings; one had massive central edema with herniation, and the other had a large intracerebral hemorrhage with herniation. The exact cause of death was unclear in 3 patients.


CONCLUSIONS
The most common neuropathology findings in this series were related to ischemia and infarction. Neuropathology findings are a significant cause of morbidity, but were only rarely the main cause of death (n = 2) in the OLT patients in this study.
Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio 44195, USA.
K F
KF
McCarron
R A
RA
Prayson
D000328:Adult; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology; D002493:Central Nervous System Diseases / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000473:pathology; D002544:Cerebral Infarction / Q000473:pathology; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology*