A prospective study on the neurological complications after liver transplantation

M. Guarino, A. Stracciari, R. Di Alessandro, A. Borghi, E. Gardella, P. Pazzaglla, E. Bigi, G. Martinelli, G. Grazi, E. Jovine, A. Mazziotti, A. Cavallari, L. Bassein

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We prospectively evaluated 114 consecutive patients who underwent 121 liver transplantations during 1996-1997, to define the type, frequency and etiology of post-transplant neurologic complications and to assess possible pre-transplant and operative variables related to Central Nervous System complications occurring in the first post-transplant month. We found neurologic complications in 48 patients (42) mostly involving the Central Nervous System (75). The most frequent Central Nervous System complications were stupor (16 patients), tremor (9), coma (8) and seizures (5). The main causes included cyclosporine toxicity (20), cerebral anoxic injury (12) and graft failure (12). Multiple causes were found in 10 of cases, whilst an unknown etiology was detected in 14. The Peripheral Nervous System was affected in 14 patients mainly including peroneal nerve palsy (10 patients) related to prolonged surgical positioning. Multivariate analysis indicated that the pre-transplant Child-Pugh score C was the strongest significant predictor (p = 0.03) of Central Nervous System complications, but an independent role was also discovered for severe intraoperative hypotension (p = 0.05). The occurrence of Central Nervous System complications significantly increased the mortality at 1 month (p = 0.0006). Other risk factors for mortality were Child-Pugh C (p = 0.001) and surgery duration ( > 10 hours (p = 0.02) in the univariate analysis. Multivariate model on the risk factors for mortality at 1 month confirmed the significant association with Central Nervous System complications (p = 0.03) but it also showed that Child-Pugh score C was an independent predictor of mortality (p = 0.05).

Original languageEnglish
Pages (from-to)140-145
Number of pages6
JournalGastroenterology International
Issue number3
Publication statusPublished - 1999


  • Liver transplantation
  • Neurological complications
  • Outcome
  • Risk factors

ASJC Scopus subject areas

  • Gastroenterology


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