Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jul 19, 2025; 15(7): 104812
Published online Jul 19, 2025. doi: 10.5498/wjp.v15.i7.104812
Meta-analysis of the incidence and risk factors of postoperative delirium in organ transplant patients
Shan-Sheng Hou, Jun Liu, Peng-Fei Qiao, Dong-Ge Yang, Liang-Fei Huang, Fei Liu, Yue Liu, Ting-Ting Jia, Hong-Liang Wang
Shan-Sheng Hou, Peng-Fei Qiao, Dong-Ge Yang, Liang-Fei Huang, Fei Liu, Yue Liu, Ting-Ting Jia, Hong-Liang Wang, Department of Organ Transplantation, The 923th Hospital of PLA Joint Logistic Support Force, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jun Liu, Organ Transplantation Research Institute, The Second Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Co-first authors: Shan-Sheng Hou and Jun Liu.
Author contributions: Hou SS, Liu J, Qiao PF, Yang DG, Huang LF, Liu F, Liu Y, Jia TT, and Wang HL acquired, analyzed, and interpreted the data; Hou SS, Liu J, and Wang HL drafted, revised, and approved the manuscript, conceived and designed the study, and critically revised and approved the final manuscript.
Supported by the Health Commission of Guangxi Zhuang Autonomous Region Self-Funded Research Projects, No. Z20180575 and No. Z-A20231058.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Liang Wang, Department of Organ Transplantation, The 923th Hospital of PLA Joint Logistic Support Force, No. 52 Zhiwu Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. henry66838@163.com
Received: March 26, 2025
Revised: April 28, 2025
Accepted: May 27, 2025
Published online: July 19, 2025
Processing time: 105 Days and 19.9 Hours
Abstract
BACKGROUND

Postoperative delirium (POD) is a concerning complication of organ transplantation. With organ transplantation offering hope to patients with end-stage organ disease, understanding the incidence and risk factors of POD is crucial, as it can significantly affect patients’ prognosis and healthcare costs.

AIM

To systematically evaluate the incidence and risk factors of POD following organ transplantation to facilitate clinical prevention and optimize patient management and prognosis.

METHODS

Multiple databases such as PubMed and their reference lists were comprehensively searched using a combination of keywords related to organ transplantation and POD. Relevant observational studies on patients who had undergone solid organ transplantation and randomized controlled trials containing relevant analyses were included. Duplicated, data-deficient, non-English, and non-original data studies were excluded. Data were extracted independently by two researchers and then cross-checked. The Newcastle-Ottawa scale was used to evaluate the quality of the included studies. RevMan 5.3 was employed for data analysis. The pooled incidence of POD was calculated according to the data type, and the fixed or random effect model was employed to analyze risk factors based on heterogeneity. Subsequently, sensitivity analysis and publication bias assessments were performed.

RESULTS

A total of 39 relevant literatures were included. The overall incidence of POD in the organ transplant group was 20% [95% confidence interval (CI): 18%-22%]; liver transplant group, 22% (95%CI: 17%-26%); lung transplant group, 34% (95%CI: 23%-45%); and kidney transplant group, 6% (95%CI: 2%-10%). Primary graft dysfunction increased the POD risk, with a pooled odds ratio (OR) (95%CI) of 1.78 (1.09-2.91). A history of hepatic encephalopathy increased the POD risk, with a pooled OR (95%CI) of 3.19 (2.30-4.43). The higher the Acute Physiology and Chronic Health Evaluation II score, the greater the POD risk, with a pooled OR (95%CI) of 1.52 (1.09-2.12). A history of alcohol abuse increased the POD risk, with a pooled OR (95%CI) of 2.84 (1.74-4.65). Thus, the higher the model for end-stage liver disease score, the greater the POD risk, with a pooled OR (95%CI) of 2.49 (1.14-5.43). POD was more likely to develop in patients with preoperative infections, with a pooled OR (95%CI) of 2.78 (1.56-4.97). The use of diuretics increased the POD risk, with a pooled OR (95%CI) of 2.36 (1.38-4.04).

CONCLUSION

In this study, the overall incidence of POD in patients who underwent organ transplantation is 20%. The incidence varies among different types of organ transplantation, and multiple factors can increase the POD risk.

Keywords: Organ transplantation; Postoperative delirium; Incidence; Risk factors; Neurological complications; Meta-analysis

Core Tip: This meta-analysis aimed to precisely determine the incidence and risk factors of postoperative delirium (POD) in patients who underwent organ transplantation. By comprehensively searching multiple databases, 39 relevant studies were included. The overall incidence of POD was 20%, varying among different organ transplants. Factors such as primary graft dysfunction, hepatic encephalopathy history, high Acute Physiology and Chronic Health Evaluation II and model for end-stage liver disease scores, alcohol abuse history, preoperative infections, and diuretic use increased the risk, providing key insights for clinical practice.