Risk Factors For Intracranial Demyelination After Liver Transplantation:A Case-control Study

Objective:The incidence of intracranial demyelinating disease after LT was low and the CPM was mainly reported in the current literature. However, certain proportion of post-LT patients’ symptoms and imaging evidence are not up to the criteria for the diagnosis of CPM or EPM. So the clinical features of the patients with intracranial demyelination after LT in our hospital were summarized in this paper. The risk factors were analyzed to provide evidence for early intervention to this kind of complications.Methods:We retrospectively reviewed the 1481 records of 1,465 patients who underwent OLT between Jan 2005 and Dec 2015.7 cases of patients with intracranial disease after LT were set up as the case group and the control group was set by 1:4 matching of the age, sex and date of operation. The differences of demographic, clinical and biological parameters between the two groups were compared. Statistical analyses were performed using SPSS for windows version 20.0 software. Categorical variables were presented as numbers and percentages and compared using Fisher’s exact test (2-tailed). Continuous variables are presented as the mean ±SD and compared using the Mann-Whitney U test. In all analyses, statistical significance was defined as p<0.05.Results:Of 1,465 patients,7 (0.5%) patients were diagnosed with intracranial demyelination based on clinical presentation and neuroimaging findings. Statistical analysis showed that preoperative INR, albumin and child Pugh score, MELD score and hepatic encephalopathy had statistical significance. Preoperative serum sodium, potassium, glucose and other factors about sugery had no correlation of the intracranial demyelination after LT.Conclusions:Intracranial demyelinating lesions after LT are not always central pontine myelinolysis. Preoperative INR, albumin, child Pugh score, MELD score and hepatic encephalopathy are risk factors for the occurrence of intracranial demyelinating lesions after LT, the blood sodium which was considered as the most important risk factors in lots of literatures are not actually the risk factors.