title: Predictive factors of neurological complications and one-month mortality after liver transplantation.
abstract: BACKGROUND
  Neurological complications are common after orthotopic liver transplantation (OLT). We aimed to characterize the risk factors associated with neurological complications and mortality among patients who underwent OLT in the post-model for end-stage liver disease (MELD) era.
  
  
  METHODS
  In a retrospective review, we evaluated 227 consecutive patients at the Keck Hospital of the University of Southern California before and after OLT to define the type and frequency of and risk factors for neurological complications and mortality.
  
  
  RESULTS
  Neurological complications were common (n = 98), with encephalopathy being most frequent (56.8%), followed by tremor (26.5%), hallucinations (11.2%), and seizure (8.2%). Factors associated with neurological complications after OLT included preoperative dialysis, hepatorenal syndrome, renal insufficiency, intra-operative dialysis, preoperative encephalopathy, preoperative mechanical ventilation, and infection. Preoperative infection was an independent predictor of neurological complications (OR 2.83, 1.47-5.44). One-month mortality was 8.8% and was independently associated with urgent re-transplant, preoperative intubation, and intra-operative arrhythmia.
  
  
  CONCLUSIONS
  Neurological complications are common in patients undergoing OLT in the post-MELD era, with encephalopathy being most frequent. An improved understanding of the risk factors related to both neurological complications and one-month mortality post-transplantation can better guide perioperative care and help improve outcomes among OLT patients.
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Fu
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; Department of Hepatobiliary, Pancreas and Abdominal Organ Transplant Surgery, University of Southern California , Los Angeles, CA , USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: DiNorcia
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; Department of Hepatobiliary, Pancreas and Abdominal Organ Transplant Surgery, University of Southern California , Los Angeles, CA , USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Sher
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: Shamsha A
authors.initials: SA
authors.lastname: Velani
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Kalayjian
authors.affiliation: Keck School of Medicine, University of Southern California , Los Angeles, CA , USA ; Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
keywords: liver transplant; mortality; neurological complications