title: Neurologic problems after pediatric liver transplantation and combined liver and bowel transplantations: a single tertiary centre experience.
abstract: BACKGROUND
  Neurologic problems postpediatric liver transplant have been reported in up to 46% of cases, and mortality is higher in the pediatric age group compared with adults.
  
  
  METHODS
  An internal audit was performed in all children undergoing solid organ transplant in the Liver unit at Birmingham Children's Hospital to identify children with neurologic complications.
  
  
  RESULTS
  One hundred seventeen children underwent 127 pediatric liver transplant and combined liver and small bowel transplant episodes over a 4-year period. Neurologic problems were present after 31 of 127 (24.4%) transplant episodes involving 29 children. Seizures were the most common presentation (n=17; 54.8%), followed by encephalopathy (n=11; 35.4%) and posterior reversible leukoencephalopathy syndrome (n=6; 19.3%). Other complications noted were central nervous system infection (n=4; 12.9%), cerebrovascular accident (n=3; 9.6%), peripheral neuropathy (n=2; 6.4%) and tremor, transient blurring of vision, auditory hallucinations and choreoathetosis (n=1; 3.2%) each. There were 27 deaths (23%) in 117 children after transplantation, and the mortality rate in the group with neurologic problem was 13.3% (n=4) compared with 26.7% (n=23) in children without neurologic problem (odds ratio 0.45, 95% confidence interval 0.142-1.439). In contrast to other studies, our study showed that the mortality rate was not higher in children with neurologic problems.
  
  
  CONCLUSIONS
  Neurologic problems were relatively common after pediatric liver transplantation and combined liver and bowel transplantations; however, the mortality was lower when compared with previously reported studies.
authors.affiliation: Department of Neurology, Birmingham Children's Hospital Foundation NHS Trust, Birmingham, West Midlands, United Kingdom.
authors.forename: Daphin
authors.initials: D
authors.lastname: Fernandez
authors.forename: Tarek I
authors.initials: TI
authors.lastname: El-Azzabi
authors.forename: Vivek
authors.initials: V
authors.lastname: Jain
authors.forename: Carla
authors.initials: C
authors.lastname: Lloyd
authors.forename: Evangeline
authors.initials: E
authors.lastname: Wassmer
authors.forename: Deirdre
authors.initials: D
authors.lastname: Peake
authors.forename: Girish L
authors.initials: GL
authors.lastname: Gupte
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome