Graft factors as determinants of postoperative delirium after liver transplantation

Abstract

Post-operative delirium (POD) is a frequent complication after surgery, occurring in 15–20% of patients. POD is associated with a higher complications rate and mortality. Literature on POD after liver transplantation (LT) is limited, with the few available studies reporting an incidence of 10–47%. The aim of this study was analyzing pattern, risk factors and clinical impact of POD after LT. Data on donor and recipient characteristics, postoperative course and POD of consecutive adult LT recipients from March 2016 to May 2018 were prospectively collected and retrospectively analyzed. Risk factors for POD were analyzed using univariable logistic regression and Lasso regression. Kaplan–Meier method was used for survival analysis. 309 patients underwent LT during study period; 3 were excluded due to perioperative death. Incidence of POD was 13.4% (n = 41). The median day of onset was 5th (IQR [4–7]) with a median duration of 4 days (IQR [3–7]). Several risk factors, related to the severity of liver disease and graft characteristics, were identified. Graft macrovesicular steatosis was the only factor independently associated with POD at multivariable analysis (OR 1.27, CI 1.09–1.51, p = 0.003). POD was associated with a higher rate of severe postoperative complications and longer intensive care unit and hospital stay, but did not significantly impact on patient and graft survival. Incidence of POD after LT is comparable to that observed after general surgery and graft factors are strongly associated with its onset. These results help identifying a subset of patients to be considered for preventive interventions.

Postoperative delirium in kidney transplant patients

“…Data regarding POD in the kidney transplant (KT) population are scarce. Herein, we present the result of a systematic review (SR), showing an incidence of 5.48% among patients undergoing single organ KT and 7% in recipients of multiple organ transplant, in accordance with other reports for transplanted patients [2].…”

Predisposing and Precipitating Factors Associated With Delirium

“…Reasons for exclusion were no diagnosis by physician or research personnel (428 studies), no characterization of predisposing or precipitating factors (338 studies), retrospective study design (86 studies), not diagnosed by reference standard (108 studies), no multivariable model (43 studies), delirium assessment not conducted in person (25 studies), not cohort or case-control design (20 studies), sample included less than 50 patients (12 studies), abstract only (18 studies), cohort previously reported (3 studies), and pediatric population (1 studies). Ultimately, 315 studies…”

“…Delirium was measured by research personnel in 171 studies (54.3%), a combination of research personnel and physicians in 5 studies (1.6%), and a physician in 139 studies …”

“…We conducted a systematic review of the literature to identify predisposing and precipitating factors associated with delirium. Across 315 included studies…”

The influence of delirium on mortality and length of ICU stay and analysis of risk factors for delirium after liver transplantation

“…In a previous publication, donor factors, such as graft macrovesicular steatosis, emerged as possibly associated with the likelihood of post-LT delirium ( 33 ). We inluded recipient age and body mass index, and steatosis of liver graft into the analysis and did not find their relationship with delirium.…”