title: Evaluation of Early Postoperative Neurological Complications Following Living Donor Liver Transplantation.
abstract: BACKGROUND
  Liver transplantation is one of the best treatment options for end-stage liver disease. In Turkey, living donor liver transplantation (LDLT) is performed more frequently than cadaveric transplantation, because organ donation is unpopular in our country. Neurological complications contribute to poor postoperative outcomes after liver transplantation. In the present study, we aimed to evaluate the outcomes of LDLT patients in whom such complications developed early during postoperative follow-up in the intensive care unit.
  
  
  METHODS
  Of 217 LDLTs performed between August 2011 and August 2012, neurology consultations were arranged for 29 patients (13.36%) because of development of new-onset neurological symptoms and/or findings in patients with neurologically uneventful preoperative histories. We retrospectively collected data on age, gender, primary disease, Model for End-Stage Liver Disease (MELD) score, and postoperative hospitalization duration of those who survived. The indications for neurological consultation and diagnoses were categorized into acute confusion/encephalopathy, epileptic seizures, leukoencephalopathy, and focal neurological deficits. The immunosuppressive treatment regimens prescribed were also considered. The outcomes of the 2 groups (with and without neurological complications) were compared.
  
  
  RESULTS
  The mean patient age was 44.52±16.24 years, and males predominated (65.5%, n=19). Acute confusion/encephalopathy was the most frequent complication (62.1%, n=18), followed by epileptic seizures (27.6%, n=8), cerebrovascular disease (6.9%, n=2), and leukoencephalopathy (3.4%, n=1). Statistically significant between-group differences in age (44.5±16.2 vs. 34.33±20.98 years; p<0.001), and proportions of patients with a disease of viral etiology (55.17% vs. 35.63%, p<0.05), were evident. Mortality was significantly higher in the group with neurological complications (65.5% vs. 37.32%, p<0.05). The duration of postoperative hospitalization was also significantly longer in this group (29.80±15.04 vs. 10.00±5.47 days; p<0.05).
  
  
  CONCLUSIONS
  Mortality was significantly higher and the duration of postoperative hospitalization significantly longer in LDLT patients with new-onset neurological complications than in those without such complications.
authors.affiliation: Department of General Surgery and Institute for Liver Transplantation, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Otan
authors.affiliation: Department of General Surgery and Institute for Liver Transplantation, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Aydin
authors.affiliation: Department of General Surgery and Institute for Liver Transplantation, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Yönder
authors.affiliation: Department of General Surgery and Institute for Liver Transplantation, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of Neurology, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Kaplan
authors.affiliation: Department of General Surgery and Institute for Liver Transplantation, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
keywords: Liver transplantation; encephalopathy; immunosuppression; neurological complication