Raw Data for the article: Neurological Screening in Elderly Liver Transplantation Candidates: A Single Center

Background: Cerebral small vessels disease (cSVD) is an age-related disorder and risk factor for stroke and cognitive/motor impairments. Neurological complications (NCs) are among the causes of adverse outcomes in older liver transplant recipients. This study sought to determine whether cSVD predicts acute NCs in over 65-year-old liver transplant patients.

Methods: Data were collected, from a retrospective medical chart review, of 22 deceased donor liver transplant recipients aged 65 years or older with a pre-operative brain magnetic resonance imaging (MRI). We used the Fazekas score (0-3) as a quantitative measurement of the vascular lesion load seen in the MRI. We analyzed all post-operative acute NCs occurring during the hospital stay and any other non-NC.

Results: cSVD was recognized in all patients. Neurological complications (NCs) occurred in 18.1% of patients with toxic-metabolic encephalopathy the most frequent diagnosis (13.64%). More severe cSVD was associated with seizures (p = 0.0362), longer hospital stay (p 0.0299), and disability (p 0.0134). In our elderly cohort, hepatic encephalopathy (HE) (p 0.0287) and ascites (p 0.0270) were predictors of NCs after liver transplantation. Ascites and/or variceal bleeding and severity of liver disease were associated with adverse post-operative outcomes. The small sample size limited the statistical analysis power.

Conclusions: We present the preliminary data of a single-center retrospective study aimed at understanding the cSVD role on NCs and non-NCs after a liver transplantation in elderly patients. This would encourage a more appropriate multicenter prospective study that will definitely confirm if a neurological screening in old age liver transplant candidates is appropriate.

研究背景：脑小血管病（cerebral small vessels disease, cSVD）是一种与年龄相关的疾病，同时也是脑卒中及认知/运动功能障碍的危险因素。神经并发症（Neurological complications, NCs）是老年肝移植受者不良预后的诱因之一。本研究旨在探究脑小血管病是否可预测65岁以上肝移植患者术后急性神经并发症。

研究方法：本研究通过回顾性病历审查，收集了22例年龄≥65岁、术前接受过脑部磁共振成像（magnetic resonance imaging, MRI）检查的尸体供肝肝移植受者的临床数据。采用Fazekas量表评分（Fazekas score, 0~3分）对MRI显示的血管病变负荷进行定量评估。分析了患者住院期间发生的所有术后急性神经并发症及非神经并发症。

研究结果：所有患者均被检出存在脑小血管病。18.1%的患者发生了神经并发症，其中以中毒代谢性脑病最为常见，占比达13.64%。病情更严重的脑小血管病与癫痫发作（p=0.0362）、更长的住院时长（p=0.0299）以及残疾结局（p=0.0134）显著相关。在本老年队列中，肝性脑病（hepatic encephalopathy, HE）（p=0.0287）与腹水（p=0.0270）是肝移植术后发生神经并发症的预测因素。腹水和/或静脉曲张出血及肝病严重程度与术后不良预后相关。本研究样本量较小，限制了统计学分析的效力。

研究结论：本项单中心回顾性研究的初步数据旨在阐明脑小血管病对老年肝移植患者术后神经并发症与非神经并发症的影响。本研究结果将推动开展更具说服力的多中心前瞻性研究，以明确对老年肝移植候选者进行神经系统筛查是否具有临床必要性。