title: Neurologic complications after liver transplant: experience at a single center.
abstract: OBJECTIVE
  Neurologic complications occur frequently after liver transplants. Up to 43% of patients experience severe postsurgical neurologic complications. These complications are significantly associated with longer hospital stay, morbidity, and mortality. The aim of this retrospective study was to evaluate the type and incidence of neurologic complications after liver transplants in adult patients.
  
  
  METHODS
  We retrospectively evaluated the medical records of 176 adult patients who had undergone liver transplants between 1995 and 2013. We recorded the demographic data, type of neurologic complications, type, and level of immunosuppressive treatment, and cause of liver failure.
  
  
  RESULTS
  Our study sample consisted of 48 deceased-donor liver transplants and 128 living-donor transplants (n = 176). Fifty-three of the patients (30.1%) were female. The age range of the total sample was 18 to 66 years (mean age, 43.1 ± 13.7 y). As immunosuppressive treatment, most patients received tacrolimus alone (52%) or tacrolimus combined with mycophenolate mofetil (33%). Neurologic complications occurred in 74 of the patients (42%). The most common neurologic complications were diffuse encephalopathy (22.2%) and seizure (14.2%). Other neurologic complications were posterior reversible encephalopathy (1.7%), peripheral neuropathy (1.7%), cerebrovascular disease (1.1%), and central nervous system infection (1.1%). Age, cause of liver failure, and type of transplant were not associated with occurrence of neurologic complications.
  
  
  CONCLUSIONS
  There was a high incidence of neurologic complications after liver transplants. Diffuse encephalopathy and seizure were common complications. Physicians should be aware of the high risk of neurologic complications after liver transplants. Factors such as immunosuppressive toxicity and metabolic imbalance that predispose patients to neurologic complications after liver transplants should be evaluated immediately, and treatment of postoperative neurologic complications should be initiated as early as possible.
authors.affiliation: From the Department of Neurology, Baskent University, School of Medicine, Ankara, Turkey.
authors.forename: Eda
authors.initials: E
authors.lastname: Derle
authors.forename: Seda
authors.initials: S
authors.lastname: Kibaroğlu
authors.forename: Ruhsen
authors.initials: R
authors.lastname: Öcal
authors.forename: Mahir
authors.initials: M
authors.lastname: Kırnap
authors.forename: Ufuk
authors.initials: U
authors.lastname: Can
authors.forename: Sibel
authors.initials: S
authors.lastname: Benli
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000453:epidemiology; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents