Intracranial haemorrhage in kidney, liver and heart recipient patients: A centre experience and literature review

Abstract

Objectives

Major haemorrhagic events, including perplexing condition, intracerebral haemorrhage (ICH) are associated with significant morbidity and mortality. Treatment is planned on individual basis. A major portion of the injurious processes take place during the hours following the development of haematoma.

Organ transplantation naturally has a critical postoperative period. The complications may involve various systems of the body. We aimed to find out the incidence of haemorrhage into different compartments of the intracranial cavity in liver, kidney and heart recipient patients. We searched for possible mechanisms leading to this situation.

Materials and Methods

We retrospectively reviewed the medical files of 2524 patients who underwent either renal, liver or heart transplantations at Ankara Hospital of Başkent University during the years 1985 and 2016.

The keywords "kidney transplantation", "liver transplantation", “heart transplantation”, "intracerebral haemorrhage", "subdural haemorrhage" and "epidural haemorrhage" were also used to find the kidney, liver and heart recipient patients who experienced haemorrhage in different compartments of the intracranial cavity.

Results

Our research revealed that 25 patients have experienced intracerebral haemorrhage (ICH) at different times following kidney, liver or heart transplantation. In this group, 20 patients were kidney-transplanted, 3 patients were liver-transplanted, and 2 patients were heart-transplanted. The group included 11 female and 14 male patients. The age range was between 20 and 63 years (Table 1). One patient had an intracranial aneurysm and epidural haematoma while other 4 patients had subdural haematoma in addition to ICH. Sites of intracerebral haematoma included right frontal lobe (3 patients), right parietal lobe (5 patients), right temporal lobe (3 patients), right thalamus (4 patients), right basal ganglia (4 patients), left temporal lobe (2 patients) and left frontal lobe (4 patients). Twelve patients were treated medically. Eleven patients with subdural haemorrhage, epidural haemorrhage or intraparenchymal haemorrhage underwent craniotomy and evacuation of the haematoma. In two patients with midline shift and intraventricular extension, external ventricular drainage (EVD) was inserted. Nine patients after surgery died within 2 days to 4 months.

Conclusion

Neurological complications such as intraparenchymal haemorrhage, subdural haematoma or epidural haematoma were not uncommon in kidney, liver or heart recipients. The occurrence of these complications was associated with prolonged PT and APTT time, trauma or thrombocytopenia. These complications contributed to prolongation of hospital stay, increased in-hospital mortality, and decreased graft and patient survival.