Abstract W P318: Ischemic Stroke in the Post-Operative Phase of 2,035 Consecutive Orthotopic Liver Transplantations
Background: Cardiovascular morbidity has been cited as a prominent cause of post-operative orthotopic liver transplantation (post-OLT) complications, yet the role of ischemic stroke during this period remains poorly defined. We examined the incidence of post-OLT ischemic stroke, associated risk factors, etiology and neuroimaging features in an extensive single center database.
Methods: All consecutive adult patients undergoing OLT from January 1, 2002 to December 15, 2013 at a single center were analyzed for neurological complications, characterizing post-operative stroke by neurology consultation and CT/MRI. Neurological history, examination, features of atrial fibrillation, concomitant infection, relevant laboratory parameters, and infarct patterns were reviewed in detail.
Results: Of the 2,035 OLT cases analyzed, including 190 cases where neurology consultation was triggered, post-OLT ischemic stroke was identified in 20 patients (0.98%). Patients with ischemic stroke were significantly more likely to be older (64.4 vs. 53.6 years, p<0.001), have pre-existing coronary artery disease (21.4% vs. 5.6%, p=0.011), higher pre-transplant MELD scores (34 vs 27.7, p=0.018), and greater post-transplant infectious complications both within (45% vs 22.6%, p=0.017) and beyond (65% vs. 24.4%, p<0.001) 30 days post-OLT, and longer post-OLT length of hospitalization (53.2 vs 32.5 days, p=0.033). Comparing patients with and without post-OLT ischemic stroke, there were no significant differences in the incidence of preoperative (4.1% vs 5.0%, p=0.846) or postoperative (6.5% vs 10%, p=0.530) atrial fibrillation. Ischemic stroke was characterized with MRI in 19/20 (95%) and only CT in 1/20 (5%). Scattered, cortical lesions of probable embolic etiology were noted in 12/20 (60%) with only 3/20 (15%) proximal arterial territory lesions.
Conclusions: Post-OLT ischemic stroke was relatively uncommon in this largest single center series of 2035 consecutive OLTs. Further insight on etiology of these complications may help to further reduce morbidity.
Author Disclosures: D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. C.B. Lening: None. O. Aksoy: None. D. Liu: None. J.D. Hinman: None. F. Scalzo: None. M.S. Johnson: None. V.W. Xia: None. R.W. Busuttil: None. V.G. Agopian: None.
- © 2015 by American Heart Association, Inc.