Genetic, hematological, and immunological disorders transmissible with liver transplantation

Tan, Amy; Florman, Sander; Schiano, Thomas D.

doi:10.1002/lt.24755

Cited by 9 publications

(2 citation statements)

References 141 publications

(459 reference statements)

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“…Hypoxia, hypotension, extreme glucose levels, and electrolyte derangements (such as hypercalcemia, hypermagnesemia, hyponatremia, hypernatremia, hyposmolarity, and hyperosmolarity) can contribute to altered mentation. Although occurrences are rare, altered mental status may also result from donor transmission of metabolic diseases with neuropsychiatric complications such as urea cycle disorders and acute intermittent porphyria …”

Section: Risk Factors For Altered Mental Status After Ltmentioning

confidence: 99%

Altered mental status after liver transplant

2017

Clinical Liver Disease

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Mental status alteration occurs in up to 70% of liver transplant (LT) recipients in the early postoperative period and leads to longer hospitalizations and higher mortality rates.1 It is more frequent among patients who had alcoholic cirrhosis as the indication for LT, 2,3 metabolic liver diseases, Model for End-Stage Liver Disease (MELD) scores above 15, and were on mechanical ventilation before LT. 3 Causes cover a wide spectrum and can be multifactorial, including residual hepatic encephalopathy (HE), metabolic derangements, immunosuppressive agents and other drugs, including sedatives and narcotics, infections, renal failure, hypoxia, hemodynamic instability, and graft dysfunction (Table 1). These conditions can also lead to seizures, which by themselves are also frequently accompanied by altered mental status. This review focuses on etiologies of altered mental status that are specific and applicable to LT recipients.HE is a common manifestation of decompensated cirrhosis that results from inadequate metabolism of ammonia and other toxins by the failing liver and/or from significant shunting of the portal blood away from the liver through collateral vessels. It is an independent predictor of neurological complications after LT, but it typically resolves fairly rapidly within the first few days after LT in the setting of a functioning graft. In a few patients, however, early allograft dysfunction or persistence of large spontaneous portosystemic shunts may promote persistent HE after LT, until graft function improves or the shunts are ligated or embolized. Patients who undergo LT with severe HE, alcohol-related liver disease, or high MELD scores may have slower resolution of HE after LT, 4 but failure of a patient to awaken after LT should prompt a thorough investigation.Immunosuppressive agents administered after LT can cause alterations in mental status, and concomitant drugs that inhibit their metabolism may exacerbate this complication. Corticosteroids can cause confusion, mood disturbances, manic states, or psychosis, which improve Abbreviations: CNS, central nervous system; CPM, central pontine myelinolysis; FLAIR, fluid attenuation inversion recovery; HE, hepatic encephalopathy; LT, liver transplant; MELD, Model for End-Stage Liver Disease; MRI, magnetic resonance imaging; ODS, osmotic demyelination syndrome; PRES, posterior reversible leukoencephalopathy syndrome.

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Section: Risk Factors For Altered Mental Status After Ltmentioning

confidence: 99%

Altered mental status after liver transplant

2017

Clinical Liver Disease

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“…A recent overview by Tan et al . provides valuable information about various metabolic diseases that have been transmitted by liver transplantation. They range from the relatively common and unproblematic such as Gilbert's syndrome to the rare and fatal such as previously undetected urea cycle disorders, in particular ornithine transcarbamylase deficiency.…”

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confidence: 99%