Neuropathology of pediatric liver transplantation

Pediatric Neuroscience
W A Hall, A J Martinez

Abstract

We reviewed the clinical histories and autopsy records of 35 pediatric patients (ranging in age from 9 months to 18 years) who underwent orthotopic liver transplantation using ciclosporin and corticosteroids for immunosuppression. At the time of death, 19 children (54%) had encephalopathy, 16 (46%) were lethargic or in coma, 10 (29%) had seizures, and 10 were normal. Neuropathological lesions were found on postmortem examination in all 35 patients. Vascular lesions such as infarction, ischemia, thrombosis, and hemorrhage were the most common neuropathological findings (86%) followed by infectious processes (29%). Candida albicans (2 patients) and Aspergillus fumigatus (3 patients) were the only offending organisms identified, both causing meningoencephalitis. Alzheimer type II astrocytes, a characteristic feature of chronic liver disease, were the single most common autopsy finding (69%). Central pontine myelinolysis was seen in 3 children and basilar artery thrombosis affected 1 child. Neurological complications and their subsequent neuropathology are a significant cause of morbidity and mortality after pediatric liver transplantation. Vascular insults, electrolyte abnormalities, and infections that involve the central nervous...Continue Reading

Citations

Jan 1, 1992·Acta Neuropathologica·J A FerreiroH V Vinters
Apr 6, 2002·Brain & Development·Takeo KatoKoichi Tanaka
Feb 1, 1997·Seizure : the Journal of the British Epilepsy Association·Z K Wszolek, R E Steg
Aug 1, 2006·Pediatric Neurology·Chalmer D McClureStephen Ashwal
May 19, 2007·International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases·John DotisEmmanuel Roilides
Jun 1, 2012·Journal of Child Neurology·Adrianna M RangerDouglas Fraser
Nov 1, 1994·Annals of Neurology·R A Patchell
May 8, 2019·Archives of Pathology & Laboratory Medicine·Apeksha N Agarwal, Daniel D Mais
Dec 1, 1992·Annals of Neurology·A R BickneseW E Dodson
Mar 28, 1998·Neurologic Clinics·J M Lee, E C Raps

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