Neurologic Complications After Liver Transplant: Experience at a Single Center

Abstract

Objectives: Neurologic complications occur frequently after liver transplants. Up to 43% of patients experience severe postsurgical neurologic complications. These complications are significantly associated with longer hospital stay, morbidity, and mortality. The aim of this retrospective study was to evaluate the type and incidence of neurologic complications after liver transplants in adult patients. Materials and Methods:We retrospectively evaluated the medical records of 176 adult patients who had undergone liver transplants between 1995 and 2013. We recorded the demographic data, type of neurologic complications, type, and level of immunosuppressive treatment, and cause of liver failure. Results: Our study sample consisted of 48 deceaseddonor liver transplants and 128 living-donor transplants (n = 176). Fifty-three of the patients (30.1%) were female. The age range of the total sample was 18 to 66 years (mean age, 43.1 ± 13.7 y). As immunosuppressive treatment, most patients received tacrolimus alone (52%) or tacrolimus combined with mycophenolate mofetil (33%). Neurologic complications occurred in 74 of the patients (42%). The most common neurologic complications were diffuse encephalopathy (22.2%) and seizure (14.2%). Other neurologic complications were posterior reversible encephalopathy (1.7%), peripheral neuropathy (1.7%), cerebrovascular disease (1.1%), and central nervous system infection (1.1%). Age, cause of liver failure, and type of transplant were not associated with occurrence of neurologic complications. Conclusions: There was a high incidence of neurologic complications after liver transplants. Diffuse encephalopathy and seizure were common complications. Physicians should be aware of the high risk of neurologic complications after liver transplants. Factors such as immunosuppressive toxicity and metabolic imbalance that predispose patients to neurologic complications after liver transplants should be evaluated immediately, and treatment of postoperative neurologic complications should be initiated as early as possible.

Prevalence and Treatment of Neuropathic Pain in Kidney and Liver Transplant Recipients

“…1 Derle and colleagues found a prevalence of peripheral neuropathy of 1.7% after liver transplant. 6 We found a neuropathic pain prevalence of 6.2%. This was brought about by a greater number of patients with diabetes and the longer follow-up (as long as 8 years among transplant recipients).…”

“…[1][2][3][4][5][6] Ramos and associates reported a neuropathic pain prevalence of 1.4% among 140 solid-organ transplant recipients. 1 Derle and colleagues found a prevalence of peripheral neuropathy of 1.7% after liver transplant.…”

“…2 The causes of neuropathic pain in transplant recipients include uremia, diabetes, inflammatory disorders, conditions secondary to immunosuppressive agents, zona zoster infections, cancer, and central disorders such as stroke and spinal cord injuries. [3][4][5][6] …”

Seizures after transplantation

“…In recent years, there has been a decreasing trend in the incidence of this type of seizure, which may be due to timely postoperative managements that include correcting metabolic disorders, dealing with poisoning and using immunosuppressive agents with fewer side effects [52]. [53] conducted a survey of 176 patients who had received liver transplants between 1955 and 2013 and found that approximately 6% of the adult patients had seizures. Only two of the patients showed SE or focal awareness impaired seizure, and the others were characterized as GTCSs.…”

“…Wszolek et al [51] found that there are two peaks of seizure occurrence after transplantation, namely, the first week and the fifth to sixteenth weeks after surgery. Adult patients usually experience seizures in the early postoperative period [51,[53][54][55][56]. Xie et al [54] found that pediatric patients often show seizures within the first two weeks after liver transplantation; this idea was supported by Kılıç et al [55].…”