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Perioperative Neurological Complications After Liver Transplantation are Best Predicted by Pre-transplant Hepatic Encephalopathy

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Abstract

Introduction

Liver transplant (LT) recipients are at significant risk for the development of neurological complications, such as altered mental status and seizures, in the postoperative period. Identifying accurate predictors of these events may allow optimal selection and preparation of candidates, and minimize risk after transplantation.

Methods

One hundred and one consecutive adult LT recipients were evaluated retrospectively for neurological morbidity occurring in the first 30 days postoperatively. These events were analyzed in relation to specific predictive variables including preoperative complications of liver failure, such as hepatic encephalopathy (HE).

Results

Median age was 50 years, 63% were male and hepatitis C was the most common indication for LT (n = 36). Median Child-Pugh score was 9 with 45% being Class C. Over half (n = 52) had experienced clinical HE prior to LT, while one quarter (n = 26) were encephalopathic at the time of LT. Neurological complications occurred in 31 patients in the postoperative period, with encephalopathy occurring in 28 and seizures occurring in 4; drug toxicity was responsible for neurological morbidity in 12 patients (39%). Length of hospital stay was significantly prolonged (median 19 vs. 12 days, P = 0.005) and all mortality (n = 3) occurred in those with neurological complications. There was no association between etiology of liver failure and complications; logistic regression identified active preoperative HE as the strongest predictor of postoperative morbidity (OR 10.7 95% CI 3.8–29.9).

Conclusion

Neurological events, manifesting most often as encephalopathy, occurred in almost one-third of patients after LT. Those suffering from HE at the time of LT may be more vulnerable to the metabolic stresses of surgery and the neurotoxicity of the drugs used, and were at highest risk for such complications.

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References

  1. Moore KA, Jones R, Burrows GD. Quality of life and cognitive function of liver transplant patients: a prospective study. Liver Transpl. 2000;6:633–2.

    Article  PubMed  CAS  Google Scholar 

  2. Mazariegos GV, Molmenti EP, Kramer DJ. Early complications after orthotopic liver transplantation. Surg Clin N Am 1999;79:109–29.

    Article  PubMed  CAS  Google Scholar 

  3. Lodi R, Tonon C, Stracciari A, et al. Diffusion MRI shows increased water apparent diffusion coefficient in the brain of cirrhotics. Neurology 2004;62:762–6.

    PubMed  CAS  Google Scholar 

  4. Weissenborn K, Bokemeyer M, Ahl B, et al. Functional imaging of the brain in patients with liver cirrhosis. Metab Brain Dis 2004;19:269–80.

    Article  PubMed  Google Scholar 

  5. Adams DH, Ponsford S, Gunson B, et al. Neurological complications following liver transplantation. Lancet 1987;1(8539):949–51.

    Article  PubMed  CAS  Google Scholar 

  6. Guarino M, Stracciari A, Pazzaglia P, et al. Neurological complications of liver transplantation. J Neurol 1996;243:137–42.

    Article  PubMed  CAS  Google Scholar 

  7. Lewis MB, Howdle PD. Neurological complications of liver transplantation in adults. Neurology 2003;61:1174–8.

    PubMed  CAS  Google Scholar 

  8. Menegaux F, Keefe EB, Andrews BT, et al. Neurological complications of liver transplantation in adult versus pediatric patients. Transplantation 1994;58:447–50.

    Article  PubMed  CAS  Google Scholar 

  9. Borhani Haghighi A, Malekhosheini SA, Bahramali E, et al. Neurological complications of first 100 orthotopic liver transplantation patients in southern Iran. Transplant Proc 2005;37:3197–9.

    Article  PubMed  Google Scholar 

  10. Bronster DJ, Emre S, Boccagni P, Sheiner PA, Schwartz ME, Miller CM. Central nervous system complications in liver transplant recipients—incidence, timing, and long-term follow-up. Clin Transplant 2000;14:1–7.

    Article  PubMed  CAS  Google Scholar 

  11. Bechstein WO. Neurotoxicity of calcineurin inhibitors: impact and clinical management. Transpl Int 2000;13:313–26.

    Article  PubMed  CAS  Google Scholar 

  12. Pujol A, Graus F, Rimola A, et al. Predictive factors of in-hospital CNS complications following liver transplantation. Neurology 1994;44:1226–30.

    PubMed  CAS  Google Scholar 

  13. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus in bleeding oesophageal varices. Br J Surg 1973;60:646–9.

    Article  PubMed  CAS  Google Scholar 

  14. Aggarwal S, Kang Y, Freeman JA, Fortunato Jr FL, Pinksy MR. Postreperfusion syndrome: hypotension after reperfusion of the transplanted liver. J Crit Care 1993;8:154–60.

    Article  PubMed  CAS  Google Scholar 

  15. Vecino MC, Cantisani G, Zanotelli ML, et al. Neurological complications in liver transplantation. Transplant Proc 1999;31:3048–9.

    Article  PubMed  CAS  Google Scholar 

  16. Glass GA, Stankiewicz J, Mithoefer A, Freeman R, Bergethon PR. Levetiracetam for seizures after liver transplantation. Neurology 2005;64:1084–5.

    PubMed  CAS  Google Scholar 

  17. Wijdicks EF, Plevak DJ, Wiesner RH, Steers JL. Causes and outcome of seizures in liver transplant recipients. Neurology 1996;47:1523–5.

    PubMed  CAS  Google Scholar 

  18. Abbasoglu O, Goldstein RM, Vodapally MS, et al. Liver transplantation in hyponatremic patients with emphasis on central pontine myelinolysis. Clin Transplant 1998;12:263–9.

    PubMed  CAS  Google Scholar 

  19. Buis IC, Wiesner RH, Krom RA, Kremers WK, Wijdicks EF. Acute confusional state following liver transplantation for alcoholic liver disease. Neurology 2002;59:601–5.

    Article  PubMed  Google Scholar 

  20. Haussinger D, Kircheis G, Fischer R, Schliess F, vom Dahl S. Hepatic encephalopathy in chronic liver disease: a clinical manifestation of astrocyte swelling and low-grade cerebral edema? J Hepatol 2000;32:1035–8.

    Article  PubMed  CAS  Google Scholar 

  21. Laubenberger J, Haussinger D, Bayer S, Guffler H, Hennig J, Langer M. Proton magnetic resonance spectroscopy of the brain in symptomatic and asymptomatic patients with liver cirrhosis. Gastroenterology 1997;112:1610–6.

    Article  PubMed  CAS  Google Scholar 

  22. Haussinger D, Schliess F. Astrocyte swelling and protein tyrosine nitration in hepatic encephalopathy. Neurochem Int 2005;47:64–70.

    Article  PubMed  CAS  Google Scholar 

  23. Mattarozzi K, Stracciari A, Vignatelli L, D’Allessandro R, Morelli MC, Guarino M. Minimal hepatic encephalopathy: longitudinal effects of liver transplantation. Arch Neurol 2004;61:242–7.

    Article  PubMed  Google Scholar 

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Correspondence to Rajat Dhar.

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Dhar, R., Young, G.B. & Marotta, P. Perioperative Neurological Complications After Liver Transplantation are Best Predicted by Pre-transplant Hepatic Encephalopathy. Neurocrit Care 8, 253–258 (2008). https://doi.org/10.1007/s12028-007-9020-4

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