Therapy of central pontine myelinolysis following living donor liver transplantation: Report of three cases

Abstract

We analyzed the clinical manifestations and experiences of diagnosing and treating central pontine myelinolysis following living donor liver transplantation. The clinical data of three patients with central pontine myelinolysis following living donor liver transplantation from January 2005 to November 2007 were retrospectively analyzed at the West China Hospital, Sichuan University, China. The three patients developed hyponatremia prior to surgery. Case 1 suffered locked-in syndrome following surgery, and received a large dose of gamma globulin, and subsequently recovered. Case 2 was in a coma for three days, and received hyperbaric chamber treatment. This patient remained in a mild coma for six months following surgery. Case 3 developed consciousness disturbances, gradually went into a coma following surgery, and died due to pulmonary infection. Central pontine myelinolysis is a severe complication in patients following living donor liver transplantation. Large-dose gamma globulin treatment, as well as hyperbaric oxygen, might be effective therapeutic methods.

Figure 1

Magnetic resonance imaging displayed high-signal intensity on T2-weighted images of the central pons 7 d after surgery (arrow).

Figure 2

Magnetic resonance imaging displayed high-signal intensity on T2-weighted images of the central pons 9 d (A) and 8 d (B) after surgery (arrows).