Early Neurological Complications Following Pediatric Liver Transplantation

INTRODUCTION: Liver transplantation (LT) is a curative treatment for end-stage liver diseases. There is a paucity of data regarding early neurological complications after liver transplantation in the pediatric population. Our aim is to present the characteristics and clinical findings of pediatric patients with early neurological complications (NC) following liver transplantation. METHODS: We conducted a retrospective study conducted in a tertiary pediatric referral center which serves as a national liver transplant center. All children who underwent liver transplantation between 2017 and 2021 were included. Data were collected from medical files during the first 3 months after transplantation, and risk factor analysis for neurological complications was carried out. RESULTS: Of 79 patients who underwent LT, 17 (21.5%) experienced NC. Forty five (57%) were males and the mean age was 2.8 years (range 4 months to 18 years). The most common indication for transplantation was biliary atresia (n = 29, 37.2%), followed by metabolic disorders (n = 16, 20.5%). Living donor liver transplantation was performed in 39 cases (49.4%). The most common neurologic manifestations were seizures (n = 5, 29% of NC), followed by neuropathy (n = 4, 24%), encephalopathy (n = 3, 18%), myoclonus, tremors, and headaches (n = 2, 12%). There was no significant difference in the presence of NC between gender, underlying disease, type of transplant, neurological symptoms pre-transplantation and coagulopathy post transplantation. Age was not found to be an independent risk factor, however there was a trend of higher NC in older patients. Type of immunosuppression protocol, was surprisingly not associated with NC. CONCLUSIONS: Early NC are common (21.5%) in pediatric LT recipients, with seizures being the most frequent manifestation. While predisposing factors were not identified in this cohort, this study characterizes the clinical spectrum of these serious complications.