Skip to main content
SpringerLink
Log in
Book cover

Liver Anesthesiology and Critical Care Medicine pp 267–282Cite as

Liver Transplantation: The Patient with Severe Co-morbidities, CNS Disease and Increased Intracranial Pressure

  • Chapter
  • First Online:

Abstract

Intracranial hypertension (ICH) is a common cause of death in acute liver failure (ALF) [1]. The concept cerebral oedema and hyperaemia as a cause of the acute rise in intracranial pressure (ICP) in ALF is relatively novel and was first described in the early 1970s [2]. ICH is present in up to 75 % of ALF patients with grade IV encephalopathy [3] and leads to decreased cerebral perfusion and risk of transtentorial herniation. The onset of ICH in ALF is rapid and allows insufficient time for adaptive processes. The underlying aetiology is likely to be multifactorial.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. O’Grady JG, Alexander GJ, Hayllar KM, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97(2):439–45.

    PubMed  Google Scholar 

  2. Ware AJ, D’Agostino AN, Combes B. Cerebral edema: a major complication of massive hepatic necrosis. Gastroenterology. 1971;61:877–84.

    PubMed  CAS  Google Scholar 

  3. Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137(12):947–54.

    PubMed  Google Scholar 

  4. Bernal W, Hall C, Karvellas CJ, et al. Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology. 2007;46:1844–52.

    Article  PubMed  CAS  Google Scholar 

  5. Clemmesen JO, Larsen FS, Kondrup J, et al. Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology. 1999;29:648–53.

    Article  PubMed  CAS  Google Scholar 

  6. Norenberg MD, Rao KV, Jayakumar AR. Mechanisms of ammonia-induced astrocyte swelling. Metab Brain Dis. 2005;20:303–18.

    Article  PubMed  CAS  Google Scholar 

  7. Swain M, Butterworth RF, Blei AT. Ammonia and related amino acids in the pathogenesis of brain edema in acute ischemic liver failure in rats. Hepatology. 1992;15:449–53.

    Article  PubMed  CAS  Google Scholar 

  8. Record CO, Buxton B, Chase RA, Curzon G, Murray-Lyon IM, Williams R. Plasma and brain amino acids in fulminant hepatic failure and their relationship to hepatic encephalopathy. Eur J Clin Invest. 1976;6:387–94.

    Article  PubMed  CAS  Google Scholar 

  9. Tofteng F, Hauerberg J, Hansen BA, et al. Persistent arterial hyperammonemia increases the concentration of glutamine and alanine in the brain and correlates with intracranial pressure in patients with fulminant hepatic failure. J Cereb Blood Flow Metab. 2006;26:21–7.

    Article  PubMed  CAS  Google Scholar 

  10. Butterworth RF. Molecular neurobiology of acute liver failure. Semin Liver Dis. 2003;23:251–8.

    Article  PubMed  CAS  Google Scholar 

  11. Ranjan P, Mishra AM, Kale R, Saraswat VA, Gupta RK. Cytotoxic edema is responsible for raised intracranial pressure in fulminant hepatic failure: in vivo demonstration using diffusion-weighted MRI in human subjects. Metab Brain Dis. 2005;20:181–92.

    Article  PubMed  Google Scholar 

  12. Jalan R, Pollock A, Shah SH, et al. Liver derived pro-inflammatory cytokines may be important in producing intracranial hypertension in acute liver failure. J Hepatol. 2002;37:536–8.

    Article  PubMed  CAS  Google Scholar 

  13. Olafsson S, Gottstein J, Blei AT. Brain edema and intracranial hypertension in rats after total hepatectomy. Gastroenterology. 1995;108:1097–103.

    Article  PubMed  CAS  Google Scholar 

  14. Detry O, Arkadopoulos N, Ting P, Kahaku E, Margulies J, Arnaout W, et al. Intracranial pressure during liver transplantation for fulminant hepatic failure. Transplantation. 1999;67:767–70.

    Article  PubMed  CAS  Google Scholar 

  15. Jalan R, Pollok A, Shah SH, Madhavan K, Simpson KJ. Liver derived pro-inflammatory cytokines may be important in producing intracranial hypertension in acute liver failure. J Hepatol. 2002;37:536–8.

    Article  PubMed  CAS  Google Scholar 

  16. Larsen FS, Ejlersen E, Hansen BA, Knudsen GM, Tygstrup N, Secher NH. Functional loss of cerebral blood flow autoregulation in patients with fulminant hepatic failure. J Hepatol. 1995;23:212–7.

    Article  PubMed  CAS  Google Scholar 

  17. Blei AT. The pathophysiology of brain edema in acute liver failure. Neurochem Int. 2005;47:71–7.

    Article  PubMed  CAS  Google Scholar 

  18. Vaquero J, Polson J, Chung C, Helenowski I, Schiodt FV, Reisch J, et al. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology. 2003;125:755–64.

    Article  PubMed  Google Scholar 

  19. Stravitz RT, Kramer AH, Davern T, Obaid A, Shaikh S, Caldwell SH, et al. The Acute Liver Failure Study Group intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group. Crit Care Med. 2007;35(11):2498–508.

    Article  PubMed  Google Scholar 

  20. Munoz SJ, Robinson M, Northrup B, Bell R, Moritz M, Jarrell B, et al. Elevated intracranial pressure and computed tomography of the brain in fulminant hepatocellular failure. Hepatology. 1991;13:209–12.

    Article  PubMed  CAS  Google Scholar 

  21. Traber PG, Ganger DR, Blei AT. Brain edema in rabbits with galactosamine-induced fulminant hepatitis. Regional differences and effects on intracranial pressure. Gastroenterology. 1986;91:1347–56.

    PubMed  CAS  Google Scholar 

  22. Detry O, De Roover A, Honoré P, Meuriss M. Brain edema and intracranial hypertension in fulminant hepatic failure: pathophysiology and management. World J Gastroenterol. 2006;12(46):7405–12.

    PubMed  Google Scholar 

  23. Davies MH, Mutimer D, Lowes J, et al. Recovery despite impaired cerebral perfusion in fulminant hepatic failure. Lancet. 1994;343:1329–30.

    Article  PubMed  CAS  Google Scholar 

  24. Blei AT, Olafsson S, Webster S, et al. Complications of intracranial pressure monitoring in fulminant hepatic failure. Lancet. 1993;341:157–8.

    Article  PubMed  CAS  Google Scholar 

  25. Vaquero J, Fontana RJ, Larson AM, et al. Complications and use of intracranial pressure monitoring in patients with acute liver failure and severe encephalopathy. Liver Transpl. 2005;11:1581–9.

    Article  PubMed  Google Scholar 

  26. Peck M, Wendon J, Sizer E, Auzinger G, Bernal W. Intracranial pressure monitoring in acute liver failure: a review of 10 years experience. Crit Care. 2010;14(Suppl 1):P542, S182.

    Google Scholar 

  27. Sheinberg M, Kanter MJ, Robertson CS, Constant CF, Narayan RK, Grossman RG. Continuous monitoring of jugular venous oxygen saturation in head injured patients. J Neurosurg. 1992;76:212–71.

    Article  PubMed  CAS  Google Scholar 

  28. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Intracranial pressure thresholds. J Neurotrauma. 2007;24:S55–8.

    Google Scholar 

  29. Ede RJ, Gimson AE, Bihari D, Williams R. Controlled hyperventilation in the prevention of cerebral oedema in fulminant hepatic failure. J Hepatol. 1986;2:43–51.

    Article  PubMed  CAS  Google Scholar 

  30. Kodakat S, Gopal P, Wendon J. Hyperglycaemia is associated with intracranial hypertension in patients with acute liver failure. Abstr Liver Transpl. 2001;7:C-21.

    Google Scholar 

  31. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.

    Article  PubMed  Google Scholar 

  32. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449–61.

    Article  PubMed  Google Scholar 

  33. Meier R, Béchir M, Ludwig S, Sommerfeld J, Keel M, Steiger P, et al. Differential temporal profile of lowered blood glucose levels (3.5 to 6.5 mmol/l versus 5 to 8 mmol/l) in patients with severe traumatic brain injury. Crit Care. 2008;12:R98.

    Article  PubMed  Google Scholar 

  34. Vaquero J, Polson J, Chung C, et al. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology. 2003;125:755–64.

    Article  PubMed  Google Scholar 

  35. Rolando N, Harvey F, Brahm J, et al. Fungal infection: a common, unrecognised complication of acute liver failure. J Hepatol. 1991;12:1–9.

    Article  PubMed  CAS  Google Scholar 

  36. Rees C, Oppong K, Al Mardini H, Hudson M. Record effect of L-ornithine L-aspartate on patients with and without TIPS undergoing glutamine challenge: a double-blind placebo controlled trial. Gut. 2000;47:571–4.

    Article  PubMed  CAS  Google Scholar 

  37. Acharya SK, Bhatia V, Sreenivas V, Khanal S, Panda SK. Efficacy of L-ornithine L-aspartate in acute liver failure: a double-blind, randomized, placebo-controlled study. Gastroenterology. 2009;136(7):2159–68.

    Article  PubMed  CAS  Google Scholar 

  38. Marshall LF, Smith RW, Rauscher LA, et al. Mannitol dose requirements in brain injured patients. J Neurosurg. 1978;48:169–72.

    Article  PubMed  CAS  Google Scholar 

  39. Himmelseher S. Hypertonic saline solutions for treatment of intracranial hypertension. Curr Opin Anaesthesiol. 2007;20:414–26.

    Article  PubMed  Google Scholar 

  40. Murphy N, Auzinger G, Bernal W, Wendon J. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology. 2004;39:464–70.

    Article  PubMed  CAS  Google Scholar 

  41. Robertson C, Valadka A, Hannay H, Contant C, Gopinath S, Cormio M, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999;27:2086–95.

    Article  PubMed  CAS  Google Scholar 

  42. Lang EW, Czosnyka M, Mehdorn HM. Tissue oxygen reactivity and cerebral autoregulation after severe traumatic brain injury. Crit Care Med. 2003;31:267–71.

    Article  PubMed  CAS  Google Scholar 

  43. Balestreri M, Czosnyka M, Hutchinson P, Steiner LA, Hiler M, Smielewski P, et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care. 2006;4:8–13.

    Article  PubMed  Google Scholar 

  44. Clemmesen JO, Hansen BA, Larsen FS. Indomethacin normalizes intracranial pressure in acute liver failure: a twenty-three year-old woman treated with indomethacin. Hepatology. 1997;26:1423–5.

    Article  PubMed  CAS  Google Scholar 

  45. Tofteng F, Larsen FS. The effect of indomethacin on intracranial pressure, cerebral perfusion, and extracellular lactate and glutamate concentrations in patients with fulminant hepatic failure. J Cereb Blood Flow Metab. 2004;24:798–804.

    Article  PubMed  CAS  Google Scholar 

  46. Jalan R, Olde Damink SW, Deutz NE, et al. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology. 2004;127:1338–46.

    Article  PubMed  CAS  Google Scholar 

  47. Bismuth H, Samuel D, Castaing D, et al. Orthotopic liver transplantation in fulminant and subfulminant hepatitis. Ann Surg. 1995;222:109.

    Article  PubMed  CAS  Google Scholar 

  48. Keays R, Potter D, O’Grady J, Peachey T, Alexander G, Williams R. Intracranial and cerebral perfusion pressure changes before, during and immediately after orthotopic liver transplantation for fulminant hepatic failure. Q J Med. 1991;79:425.

    PubMed  CAS  Google Scholar 

  49. Lidofsky SD, Bass NM, Prager NM, et al. Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure. Hepatology. 1992;16:1.

    Article  PubMed  CAS  Google Scholar 

  50. Donovan JP, Schafer DF, Shaw BW, Sorrell MF. Cerebral oedema and increased intracranial pressure in chronic liver disease. Lancet. 1998;351(9104):719–21.

    Article  PubMed  CAS  Google Scholar 

  51. Angeli P, Wong F, Watson H, Ginès P, CAPPS Investigators. Hyponatremia in cirrhosis: results of a patient population survey. Hepatology. 2006;44(6):1535–42.

    Article  PubMed  CAS  Google Scholar 

  52. Amodio P, Biancardi A, Montagnese S, Angeli P, Iannizzi P, Cillo U, et al. Neurological complications after orthotopic liver transplantation. Dig Liver Dis. 2007;39(8):740–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Liver Intensive Care Unit, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Chris Willars & Georg Auzinger

Authors
  1. Chris Willars
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georg Auzinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chris Willars .

Editor information

Editors and Affiliations

  1. , College of Physicians & Surgeons, Departments of Anesthesiology, of Columbia University, New York, 10032, New York, USA

    Gebhard Wagener

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Willars, C., Auzinger, G. (2012). Liver Transplantation: The Patient with Severe Co-morbidities, CNS Disease and Increased Intracranial Pressure. In: Wagener, G. (eds) Liver Anesthesiology and Critical Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5167-9_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5167-9_23

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5166-2

  • Online ISBN: 978-1-4614-5167-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation