Neurological complications following liver transplantation

Abstract

Neurological complications occurred in 4 (19%) of 21 consecutive patients (Group II) undergoing orthotopic liver transplantation, compared with a 47% (9/19) incidence in our initial series (Group I). In Group II, the neurological problems included new recurrent headaches and delayed intracerebral hemorrhage (1 patient), partial third nerve palsy and brachial plexopathy (1 patient), and ataxic dysarthria with encephalopathy (2 patients). Seizures, noted in 8 of 9 neurologically affected Group I patients, were not encountered in Group II. Of the 4 patients in the entire series with the cerebrocerebellar syndrome, 2 had partial recovery after stopping treatment with cyclosporine, 1 stabilized when cyclosporine was discontinued but later worsened when rechallenged, and 1 had full recovery but died following a second transplantation. Brain magnetic resonance images appeared normal in 3 of the 4 patients. Complications affecting vision included cortical blindness in 2 patients and occipital lobe hemorrhage in 1. All completely recovered. Survival was comparable for patients with and those without neurological complications (69% and 63%, respectively). Immediate withdrawal of cyclosporine at the onset of a change in mental status or dysarthria and improvement in intra- and postoperative management may have contributed to the decreased incidence of neurological complications.

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

“…[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.…”

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

“…La incidencia de estas complicaciones en la cohorte analizada en este estudio fue comparable a la observada en otras series (9,15,16). La nefrotoxicidad constituye un efecto secundario muy grave de la medicación inmunosupresora (2).…”

“…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.…”

“…La aparición de complicaciones neurológicas es también muy común tras el THO. Entre el 30 y el 60% de pacientes sometidos a THO experimentan trastornos neurológicos que pueden ser causados por alteraciones metabólicas, infecciones o por la toxicidad de los fármacos inmunosupresores (8,9).…”

Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications

“…10 Neurological complications post-liver transplantation are legion and include diffuse encephalopathy, seizures, intracranial hemorrhage and stroke, postoperative metabolic encephalopathy, fatal progressive neurological deterioration, peripheral nerve damage, central pontine myelinolysis, cerebral abscess, ataxia, nonencephalopathic psychosis and confabulation. [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.…”