Neurological complications after liver transplantation

Objective

In this prospective study the frequency of neurological complications causing significant morbidity and prolonging hospitalization was assessed in adult patients who underwent liver transplantation.

Patients and methods

Fourty-five adult patients who underwent liver transplantation between September 1997 and October 2003 were included into the study. Fourteen out of 45 patients (31%) died during the intraoperative or very early postoperative period. The remaining 31 patients were followed for neurological complications during their ICU stay and after being discharged to the ward. Computerized tomography, electroencephalography and electromyography (EMG), were used for diagnosis when appropriate. The clinical findings and laboratory results were recorded.

Results

Neurological complications were seen in 10 out of 31 patients (32.3%). These complications were as follows: new onset, recurrent headache (three patients), generalized seizures (two patients), persistent tremor (one patient), central pontine myelinolysis (one patient), dysartria (one patient), myopathy (one patient) and mutism (one patient). The seizures encountered in the two patients were thought to be associated with the toxic effect of tacrolimus, an immune-suppressant drug, because the seizures ceased after cessation of the drug. Myopathy presenting as quadriplegia was seen in one patient in the very early postoperative period and was diagnosed by EMG and muscle biopsy. It leaded to prolonged mechanical ventilation, ICU stay and hospitalization. The patient with central pontine myelinolysis lived in a persistent vegetative state for 2 years.

Conclusion

Neurological complications were observed in 10 out of 31 patients who underwent liver transplantation. Some of these complications were associated with the use of immune-suppressant drugs. In conclusion, neurological complications are frequently encountered after liver transplantation and are a cause of severe morbidity and prolonged ICU and hospital stay.