Incidence, risk factors, and outcomes related with neurological events after liver transplantation in adult and pediatric recipients

Abstract

Controversy exists whether NE after LT are more frequently observed in children or adults. We aimed to compare the incidence and outcomes for NE after LT in pediatric and adult recipients. A single-center cohort study, including all LT between 2001 and 2013, was performed. Definition of NE included impaired consciousness, delirium, seizures, focal neurologic deficit, visual impairment, or slurred speech. A cohort of 443 consecutive LT recipients was included: 307 adults and 136 children. Cumulative incidence of NE was similar between adults 15% (n = 41) and children 16% (n = 20; P = .73) with a complete neurological recovery in 62% and 95% of the patients, respectively (P < .0001). Adults with NE had significantly lower survival (70% vs 76%; P = .015) with a HR of 2.36; this was similarly observed in children (45% vs 66%; HR 2.05, CI 0.66; 6.34). Independent risk factors for NE in adults were pre-LT ascites, delta sodium, and post-LT hypomagnesemia, whereas in children pre-LT encephalopathy ≥II and serum albumin were associated with NE. Although a similar incidence of NE after LT was observed, children were more likely to achieve neurological recovery. Risk factors for the development of NE are difficult to assess in both populations.

Bile‐duct ligation renders the brain susceptible to hypotension‐induced neuronal degeneration: Implications of ammonia

“…Neurological complications after LT are classified into minor and major, on the basis of clinical findings and severity (Amodio et al., 2007). Minor complications include tremor, headache, sleep and mood alterations and are usually reversible, whereas seizures, cerebellar syndromes and, consciousness alterations represent major complications with serious consequences (Amodio et al., 2007; Piñero et al., 2018). The burden of these persisting neurological complications post‐LT is extensive, especially since the patient has been ‘treated’ for liver disease.…”

“…Historically, HE has always been considered to be a reversible metabolic disorder and therefore it was expected to completely resolve following LT. However, following the implantation of a new liver, persisting neurological complications remain a common problem affecting as many as 47% (8%–47%) of LT recipients (Amodio et al., 2007; Cheng et al., 2018; Kornerup et al., 2019; Piñero et al., 2018; Sotil et al., 2009). These enduring neurological complications following LT (no longer HE since the diseased liver has been replaced with a healthy one) continue to weigh severely on the patients’ quality of life, leading to longer stays in the hospital and thus causing further financial burden on health care systems (Campagna et al., 2010).…”

Liver Transplant Patients with High Preoperative Serum Bilirubin Levels Are at Increased Risk of Postoperative Delirium: A Retrospective Study

“…In addition, LT is a long and complicated surgical procedure and is associated with extensive intraoperative blood loss, frequent blood transfusions, long recovery periods in the ICU, and the postoperative use of immunosuppressive agents, all of which may contribute to the high incidence of the occurrence of postoperative neurological complications after LT [5,8]. Among neurological events, postoperative delirium is a common complication after LT, and the reported incidence of this condition varies from 9% to 32% [1][2][3]. Patients with delirium after LT require a prolonged stay in the ICU and prolonged mechanical ventilation and exhibit increased mortality.…”

“…Postoperative delirium is a common complication after liver transplantation (LT), and the reported incidence of this condition varies from 9% to 32% [1][2][3]. Delirium after LT can be caused by prior hepatic encephalopathy (HE), metabolic impairments including serum sodium changes or hypomagnesemia, severe ascites, and immunosuppressants [2,[4][5][6].…”

Trasplante hepático en un centro de Colomba: comparación de dos periodos

“…En un estudio reciente desde otro centro de trasplante en Colombia se reportaron buenos resultados: una supervivencia a 5 años del 79 %; sin embargo, debe tenerse en cuenta que en ese estudio no se incluyeron los pacientes que murieron durante los primeros 30 días (fueron el 15 % de esa cohorte), con lo cual puede existir un sesgo de los resultados (10). Con respecto a otros reportes en la región, los resultados de este estudio son superiores a los reportados recientemente por Meirelles y colaboradores desde Brasil, quienes presentan la experiencia en el Hospital Israelita Albert Einstein, en donde se encontró una supervivencia a 5 años del 74,3 % (11), por Mattos y colaboradores desde el sur de Brasil, donde la supervivencia a 5 años fue de 53 % (12); además, fue superior a lo encontrado en un estudio multicéntrico realizado en Argentina, con una supervivencia a 1 año del 81 % (13), y a lo descrito en el Hospital Austral de Buenos Aires, en donde se encontró una supervivencia a 5 años del 76 % (14).…”