pISSN 2671-8790 eISSN 2671-8804

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Korean J Transplant

Published online October 27, 2021

© The Korean Society for Transplantation

Careful neurologic examination and treatment for intracranial hemorrhage after liver transplantation in patients with alcoholic cirrhosis: case reports

Byeonggwan Noh1 , Nuri Lee2 , Jae Il Lee3 , Myunghee Yoon4

1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Hospital, Busan, Korea
2 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Veterans Health Service Medical Center, Seoul, Korea
3 Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
4 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Correspondence to: Myunghee Yoon
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan 49241, Korea
Tel: +82-51-240-7238
Fax: +82-51-247-1365
E-mail: ymh@pusan.ac.kr

Received: September 7, 2021; Revised: October 4, 2021; Accepted: October 5, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Intracranial hemorrhage (ICH) following liver transplantation is a potentially devastating complication. Although hypertension and thrombocytopenia are well-known risk factors for ICH in the general population, their roles in ICH after liver transplantation have not been well established. ICH occurred in two patients with alcoholic cirrhosis after deceased donor liver transplantation. A 38-year-old man presented with acute ICH in the right parietal lobe on day 16 after transplantation, with decreased level of consciousness and seizure. His mental status improved with immediate neurological treatment without surgery. In the second case, a 42-year-old woman had acute ICH in the left frontoparietal lobes on day 9 after transplantation, with generalized tonic-clonic seizures. Urgent cerebral decompression was performed. The patient’s neurological symptoms gradually recovered. In both cases, the blood platelet count was less than 50,000/mm3. Monitoring cerebral pressure for ICH is an invasive and challenging method, especially in patients with cirrhosis who have issues with hemostasis. Surgeons should be critically mindful of the risk of rapid neurological deterioration in patients with cirrhosis. Careful neurologic examination and immediate treatment to lower intracranial pressure for ICH after liver transplantation in patients with alcoholic cirrhosis are very important.

Keywords: Intracranial hemorrhage, Liver transplantation, Alcoholic cirrhosis, Case report