Neurologic complications after liver transplantation

Table 1 Neurologic complications of liver transplantation

Ref.	n	Total	Seizure	Stroke	Brain hemorrhage	Encephalopathy	CNS infection
Bronster et al[4]	463	20%	8.20%	0.60%	1.50%	11.8	1.2
Lewis et al[6]	657	27%	6	4%1	-1	11.0	1.1
Saner et al[7]	174	25%	2.8	0.60%	1.20%	17.8	0.0
Kim et al[5]	319	15%	1.60%	0.30%	0.60%	2.0	0.3
Vizzini et al[8]	395	16%	1%	1.30%	2.5	5.3	0.0

¹Combined ischemic strokes and brain hemorrhage. CNS: Central nervous system.

Table 2 Liver failure and associated neurologic complications

Underlying condition	Neurologic complication
Hepatic failure	Encephalopathy, acquired hepatocerebral degeneration, parkinsonism, neuropathy, myelopathy, asterixis
Wilson’s disease	Psychiatric complications, dystonia, parkinsonism
Primary biliary cirrhosis	Neuropathy, dysautonomia
Familial amyloidosis (transthyretin)	Neuropathy, dysautonomia

Table 3 Risk factors for neurologic complications after liver transplantation

Underlying condition	Neurologic complication
Chronic hyponatremia	Central pontine and extrapontine myelinolysis
High levels of immunosuppression	Immunosuppressant neurotoxicity, opportunistic infections
Endemic and nosocomial exposures	Opportunistic infections
Sepsis	CIM/CIP, septic encephalopathy
Multiple organ failure	CIM/CIP
Hepatic dysfunction	Encephalopathy
History of alcohol abuse	Encephalopathy

Modified from Linden et al[11]. CIM/CIP: Critical illness myopathy/polyneuropathy.