Central nervous system complications in liver transplant recipients--incidence, timing, and long-term follow-up.
BACKGROUND
Neurological impairment is a major source of morbidity and mortality following orthotopic liver transplantation (OLT). We reviewed our experience with neurologic complications among our first 463 consecutive adult OLT recipients.


METHODS
Between September 1988 and October 1993, 463 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications was obtained from patient charts, including autopsy results when available. CNS complications were classified by clinical presentation and by etiology.


RESULTS
93 patients (20.1%) had CNS complications following OLT. Encephalopathy (11.8%) and seizure (8.2%) were the leading complications. The incidence of immunosuppressive drug-related complications was 5.6%; coma, 1.7%; cerebral hemorrhage, 1.5%; central pontine myelinolysis (CPM), 1.2%; stroke, 0.6%; and primary CNS lymphoma, 0.2%. Most CNS events (80%) were encountered in the first month after OLT. In the majority of cases, encephalopathy (70%) and seizure (50%) presented in the first 2 wk. Although most CNS infections occurred early, 2 patients developed tuberculous meningitis more than 1 yr post-OLT. In 12 patients, death was directly related to CNS complications (2.6%).


CONCLUSIONS
Most CNS complications occur early following OLT but may be seen even after 1 yr. Patients may survive serious neurologic events, such as cerebral hemorrhage, CPM, and meningitis.
Bronster
D J
DJ
Department of Neurology, The Mount Sinai Medical Center, New York, NY, USA.
Emre
S
S
Boccagni
P
P
Sheiner
P A
PA
Schwartz
M E
ME
Miller
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000209:etiology; D002493:Central Nervous System Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000209:etiology; D012640:Seizures / Q000209:etiology; D013997:Time Factors
D007166:Immunosuppressive Agents