title: Comprehensive risk assessment for early neurologic complications after liver transplantation.
abstract: OBJECTIVE
  To determine risk factors for early neurologic complications (NCs) after liver transplantation from perspective of recipient, donor, and surgeon.
  
  
  METHODS
  In all, 295 adult recipients were enrolled consecutively between August 2001 and February 2014 from a single medical center in Taiwan. Any NC in the first 30 d post-liver transplantation, and perioperative variables from multiple perspectives were collected and analyzed. The main outcome was a 30-d NC. Generalized additive models were used to detect the non-linear effect of continuous variables on outcome, and to determine cut-off values for categorizing risk. Risk factors were identified using multiple logistic regression analysis.
  
  
  RESULTS
  In all, 288 recipients were included, of whom 142 (49.3%) experienced at least one NC, with encephalopathy being the most common 106 (73%). NCs prolonged hospital stay (35.15 ± 43.80 d vs 20.88 ± 13.58 d, P < 0.001). Liver recipients' age < 29 or ≥ 60 years, body mass index < 21.6 or > 27.6 kg/m(2), Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/mL, and postoperative intra-abdominal infection were more likely associated with NCs. Novel risk factors for NCs were donor age < 22 or ≥ 40 years, male-to-male gender matching, graft-recipient weight ratio 0.9%-1.9%, and sequence of transplantation between 31 and 174.
  
  
  CONCLUSIONS
  NCs post- liver transplantation occurs because of factors related to recipient, donor, and surgeon. Our results provide a basis of risk stratification for surgeon to minimize neurotoxic factors during transplantation.
authors.affiliation: Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Wu
authors.affiliation: Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Teng-Wei
authors.initials: TW
authors.lastname: Chen
authors.affiliation: Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: An-Chieh
authors.initials: AC
authors.lastname: Feng
authors.affiliation: Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Hsiu-Lung
authors.initials: HL
authors.lastname: Fan
authors.affiliation: Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.affiliation: Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D001927:Brain Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D003244:Consciousness Disorders / Q000453:epidemiology*; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D059413:Intraabdominal Infections / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects; D017590:Myelinolysis, Central Pontine / Q000453:epidemiology*; D020258:Neurotoxicity Syndromes / Q000453:epidemiology / Q000209:etiology; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011618:Psychotic Disorders / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology*; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D016559:Tacrolimus / Q000009:adverse effects / Q000097:blood; D013624:Taiwan / Q000453:epidemiology; D014019:Tissue Donors / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: Donor; Learning curve; Liver transplantation; Neurotoxicity syndromes; Risk