Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients

Tom K. Gallagher*, Kathryn A. Thomas, Daniela P Ladner, Daniel R Ganger, Farzaneh A Sorond, Shyam Prabhakaran, Michael Messod Abecassis, Jonathan Paul Fryer, Eric Michael Liotta

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. Methods We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. Results Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhage patients died during hospitalization. Fourteen (45%) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. Conclusions Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.

Original languageEnglish (US)
Pages (from-to)448-453
Number of pages6
JournalTransplantation
Volume102
Issue number3
DOIs
StatePublished - Mar 1 2018

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Intracranial Hemorrhages
Hemorrhage
Liver
Incidence
Odds Ratio
Confidence Intervals
Transplantation
Blood Pressure
Fibrinogen
Logistic Models
Transplant Recipients
Electronic Health Records
Bilirubin
Liver Transplantation
Hospitalization
Cross-Sectional Studies
Databases
Transplants
Mortality

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{dfb82ae022b74597b22c4d71e4af92ac,
title = "Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients",
abstract = "Background Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. Methods We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. Results Thirty-one (5.2{\%}) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26{\%}) intracranial hemorrhage patients died during hospitalization. Fourteen (45{\%}) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2{\%}, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95{\%} confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95{\%} CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95{\%} CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95{\%} CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. Conclusions Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.",
author = "Gallagher, {Tom K.} and Thomas, {Kathryn A.} and Ladner, {Daniela P} and Ganger, {Daniel R} and Sorond, {Farzaneh A} and Shyam Prabhakaran and Abecassis, {Michael Messod} and Fryer, {Jonathan Paul} and Liotta, {Eric Michael}",
year = "2018",
month = "3",
day = "1",
doi = "10.1097/TP.0000000000002005",
language = "English (US)",
volume = "102",
pages = "448--453",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients. / Gallagher, Tom K.; Thomas, Kathryn A.; Ladner, Daniela P; Ganger, Daniel R; Sorond, Farzaneh A; Prabhakaran, Shyam; Abecassis, Michael Messod; Fryer, Jonathan Paul; Liotta, Eric Michael.

In: Transplantation, Vol. 102, No. 3, 01.03.2018, p. 448-453.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients

AU - Gallagher, Tom K.

AU - Thomas, Kathryn A.

AU - Ladner, Daniela P

AU - Ganger, Daniel R

AU - Sorond, Farzaneh A

AU - Prabhakaran, Shyam

AU - Abecassis, Michael Messod

AU - Fryer, Jonathan Paul

AU - Liotta, Eric Michael

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. Methods We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. Results Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhage patients died during hospitalization. Fourteen (45%) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. Conclusions Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.

AB - Background Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. Methods We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. Results Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhage patients died during hospitalization. Fourteen (45%) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. Conclusions Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.

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U2 - 10.1097/TP.0000000000002005

DO - 10.1097/TP.0000000000002005

M3 - Article

VL - 102

SP - 448

EP - 453

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 3

ER -