Causes and treatment of intracranial hemorrhage after orthotopic liver transplantation

Objective To investigate the clinical features and prophylactico-therapeutic measures of intracranial hemorrhage after orthotopic liver transplantation(OLT).Methods The clinical data of 638 patients after OLT between January 2004 and December 2008 at the First Affiliated Hospital of Sun Yat-Sen University were analyzed retrospectively.The accumulated experiences in diagnosis and treatment of postoperative intracranial hemorrhage after OLT were reviewed.Results Among the 638 patients,10 patients(1.6%) suffered from intracranial hemorrhage.One patient happened within the first week after transplantation,3 within 2 weeks,6 within 4 weeks.Once the diagnosis is confirmed,dehydrative measures were taken immediately to decrease the intracranial pressure,and antibiotics were applied to control infection at the same time.Four patients underwent emergency craniotomy to clear the intracranial hematoma.Among 10 patients,6 patients(60.0%) died.Conclusion Intracranial hemorrhage after OLT is extremely dangerous with high mortality.Common causes of postoperative intracranial hemorrhage should be well known.Once the patients show any sign of abnormal consciousness,craniocerebral CT should be done immediately and appropriate treatments should be applied.Craniotomy should be performed to clear the hematoma when needed.