Incidence, Clinical Features, and Risk Factors of Early Neurological Complications After Orthotopic Liver Transplantation: A Single-Center Experience

BACKGROUND Despite improvements in technical and pharmacological expertise, orthotopic liver transplantation (OLT) still leads to potentially serious neurological complications (NCs) with very strong implications for graft survival, functional outcomes, and mortality. MATERIAL AND METHODS We conducted a retrospective study with the aim of defining the incidence, etiology, and clinical features of early post-OLT NCs, and we searched for preoperative, intraoperative and postoperative risk factors associated with their occurrence. RESULTS Among 376 patients who underwent OLT, 97 (25.8%) had at least 1 neurological manifestation and 24 (6.38%) had more than 1 neurological manifestation. Delirium/metabolic encephalopathy was the most frequent (14.1%), followed by seizures (3.7%) and clinical manifestations of neurotoxicity (3.7%), and then by osmotic demyelination syndrome and peripheral nervous system injury (2.9%). NCs were the cause of death in 9/97 patients, and 11 patients had severe sequelae. Having NCs was correlated with more severe liver disease, a history of chronic renal impairment, higher plasma sodium concentrations at postoperative day 2, higher perioperative delta sodium, and a higher probability of having postoperative acute renal impairment, postoperative infections, graft rejection, and more than 3 systemic complications. No preoperative neurological comorbidities were found to be risk factors for developing acute NCs early after OLT. Patients with NCs had worse outcomes: longer in-hospital length of stay, longer intensive care unit (ICU) stay, higher probability of ICU re-admission, higher probability of in-hospital death, and higher probability of needing rehabilitation after hospital discharge. CONCLUSIONS Understanding the pathophysiology of NCs after OLT may lead to the development of prevention strategies for often untreatable neurological diseases.