Predictive factors of in‐hospital CNS complications following liver transplantation

Abstract

We prospectively evaluated 84 consecutive adult patients with chronic liver disease before and after liver transplantation to define the type and frequency of post-transplant neurologic complications, and to assess possible pretransplant and operative variables associated with in-hospital CNS complications. There were 25 patients (30%) who presented 23 neurologic complications of the central and six of the peripheral nervous system. Seventy-five percent of the complications occurred in the first month post-transplant. The most frequent CNS complications included anoxic (six patients) and septic (five) encephalopathy, as well as brain hemorrhage (five). Patients who presented CNS complications had a higher mortality rate than those who did not (55% versus 17%, p = 0.002). Multiple logistic regression analysis showed abnormal pretransplant neurologic examination suggestive of chronic hepatic encephalopathy (p = 0.007) and noncholestatic liver disease (p = 0.012) to be independently associated with in-hospital CNS complications. These data indicate that CNS neurologic complications following liver transplant are common in patients with noncholestatic liver disease and are associated with increased mortality. The pretransplant neurologic examination is an important predictor of CNS complications that occur in the immediate post-transplant period.

A model to predict the development of mental status changes of unclear cause after liver transplantation

“…These findings are consistent with those of previous studies. 5,10,[12][13][14][15][16] We identified four variables as independent predictors of post-LT mental status changes of unclear cause. These variables were cause of liver disease (alcoholic liver disease and metabolic liver diseases, specifically), pre-LT mechanical ventilation, MELD score greater than 15, and nonelective LT.…”

“…Clinical data for preoperative, intraoperative, and postoperative variables previously identified as potential predictors of post-LT mental status changes of unclear cause 5,10,[12][13][14][15][16] were collected for all cases (n ϭ 40) and controls (n ϭ 40) and entered into an Excel (Microsoft Corp, Redmond, WA) database by two of the authors (F.K. and D.C.).…”

“…[1][2][3][4][5][6] These complications are a major cause of morbidity and mortality after LT. 7 In addition, post-LT neurological complications increase health care costs (mainly because of prolonged hospitalization) and worsen the health-related quality of life of these patients. 8 The most frequent clinical presentations are mental status changes (ranging from delirium to frank coma) with or without seizures.…”

Nutrition in the Management of Cirrhosis and its Neurological Complications

“…[112][113][114] The incidence of these complications is generally reported to be in the 25-75% range. 112,[115][116][117][118][119][120][121] As mentioned above, some of these "complications" may be attributable to unrecognized pre-existing neural deficits related to malnutrition.…”

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

“…Las principales causas de esta complicación son la enfermedad pretrasplante, complicaciones quirúrgicas, alteraciones metabólicas y la neurotoxicidad de los fár-macos inmunosupresores. La incidencia media de complicaciones neurológicas tras el THO es de un 30%, variando entre el 20 y el 50% en la mayoría de las series (9,(31)(32)(33)(34). En nuestro estudio, el 22% de los receptores de THO desarrollaron complicaciones neurológicas, con un tiempo medio de aparición de 7 días.…”