Characteristics of stroke after liver and kidney transplantation

Hanim Kwon; Sung Shin; Chung Hee Baek; Jun Young Chang; Dong-Wha Kang; Sun U Kwon; Jong S Kim; Bum Joon Kim

doi:10.3389/fneur.2023.1123518

Characteristics of stroke after liver and kidney transplantation

Front Neurol. 2023 Mar 22:14:1123518. doi: 10.3389/fneur.2023.1123518. eCollection 2023.

Authors

Hanim Kwon^{1

2}, Sung Shin³, Chung Hee Baek⁴, Jun Young Chang², Dong-Wha Kang², Sun U Kwon², Jong S Kim^{2

5}, Bum Joon Kim²

Affiliations

¹ Department of Neurology, Korea University Ansan Hospital, Ansan, Republic of Korea.
² Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁴ Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁵ Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.

Abstract

Background: The mechanism and characteristics of a post-transplantation stroke may differ between liver (LT) and kidney transplantation (KT), as the associated comorbidities and peri-surgical conditions are different. Herein, we investigated the characteristics and etiologies of stroke occurring after LT and KT.

Methods: Consecutive patients who received LT or KT between January 2005 to December 2020 who were diagnosed with ischemic or hemorrhagic stroke after transplantation were enrolled. Ischemic strokes were further classified according to the etiologies. The characteristics of stroke, including in-hospital stroke, perioperative stroke, stroke etiology, and timing of stroke, were compared between the LT and KT groups.

Results: There were 105 (1.8%) and 58 (1.3%) post-transplantation stroke patients in 5,950 LT and 4,475 KT recipients, respectively. Diabetes, hypertension, and coronary arterial disease were less frequent in the LT than the KT group. In-hospital and perioperative strokes were more common in LT than in the KT group (LT, 57.9%; KT, 39.7%; p = 0.03, and LT, 43.9%; KT, 27.6%; p = 0.04, respectively). Hemorrhagic strokes were also more common in the LT group (LT, 25.2%; KT, 8.6%; p = 0.01). Analysis of ischemic stroke etiology did not reveal significant difference between the two groups; undetermined etiology was the most common, followed by small vessel occlusion and cardioembolism. The 3-month mortality was similar between the two groups (both LT and KT, 10.3%) and was independently associated with in-hospital stroke and elevated C-reactive protein.

Conclusions: In-hospital, perioperative, and hemorrhagic strokes were more common in the LT group than in the KT group. Ischemic stroke subtypes did not differ significantly between the two groups and undetermined etiology was the most common cause of ischemic stroke in both groups. High mortality after stroke was noted in transplantation patients and was associated with in-hospital stroke.

Keywords: etiology; kidney transplantation; liver transplantation; prognosis; stroke.

Grants and funding

This research was supported by the Brain Convergence Research Program of the National Research Foundation (NRF), funded by the Korean government (MSIT) (No. 2020M3E5D2A01084576), and the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2020R1A2C2100077).