The neuropathology of liver transplantation: comparison of main complications in children and adults.

Neurologic complications remain important factors in mortality and morbidity of liver transplant patients, despite 5-yr survival rates of nearly 75% achieved with improved surgical and anesthetic techniques, better selection of recipients and donors, and immunosuppression. In order to analyze and compare the occurrence of neuropathologic complications in children with that in adults, we reviewed all complete autopsies done on liver transplant patients at the University of Pittsburgh from March 1, 1981 until December 31, 1990. A retrospective study of all neuropathologic lesions in 68 children and 132 adults indicated a higher occurrence of cerebrovascular lesions in children than in adults. Intracranial hemorrhages occurred in 27% of the children and in 20% of adults; cerebral ischemic lesions showed even a higher prevalence in children than in adults: focal infarcts occurred in 32% of children and 18% of adults, and global brain ischemia was observed in 49% of children and 20% of adults. Intracranial aspergillosis was the most common fungal infection in both children and adults (4% children, 10% adults). Systemic posttransplant lymphoproliferative disorders were more frequent in children and occurred in nine children and four adults. CNS lymphoma occurred in two children and one adult. Progressive multifocal leukoencephalopathy was seen in one adult only.