Hepatopulmonary syndrome and venous emboli causing intracerebral hemorrhages after liver transplantation: A case report

Gary A. Abrams, Kenneth Rose, Michael B. Fallon, Brendan M. McGuire, Joseph R. Bloomer, Dirk J. Van Leeuwen, Tamara Tutton, Marty T. Sellers, Devin E. Eckhoff, J. Steven Bynon

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Increasing experience has fostered the acceptance of liver transplantation as a treatment for patients with hepatopulmonary syndrome. Morbidity and mortality is most commonly attributed to progressive arterial hypoxemia postoperatively. A cerebral hemorrhage has been reported in one patient with hepatopulmonary syndrome after transplantation. However, a postmortem examination of the brain was not performed and the pathogenesis or type of cerebral hemorrhage was undefined. We report on a patient with severe hepatopulmonary syndrome who developed multiple intracranial hemorrhages after transplantation. The intracerebral hemorrhages were most consistent with an embolic etiology on postmortem examination. We postulate that venous embolization, caused by the manipulation of a Swan Ganz catheter in a thrombosed central vein, resulted in pulmonary emboli that passed through dilated intrapulmonary vessels into the cerebral microcirculation. Special attention to central venous catheters and avoidance of manipulation may be warranted in subjects with severe hepatopulmonary syndrome after liver transplantation.

Original languageEnglish (US)
Pages (from-to)1809-1811
Number of pages3
JournalTransplantation
Volume68
Issue number11
DOIs
StatePublished - Dec 15 1999
Externally publishedYes

ASJC Scopus subject areas

  • Transplantation

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