PREDICTIVE FACTORS OF IN-HOSPITAL CNS COMPLICATIONS FOLLOWING LIVER-TRANSPLANTATION

We prospectively evaluated 84 consecutive adult patients with chronic liver disease before and after liver transplantation to define the typ e and frequency of post-transplant neurologic complications, and to as sess possible pretransplant and operative variables associated with in -hospital CNS complications. There were 25 patients (30%) who presente d 23 neurologic complications of the central and six of the peripheral nervous system. Seventy-five percent of the complications occurred in the first month post-transplant. The most frequent CNS complications included anoxic (six patients) and septic (five) encephalopathy, as we ll as brain hemorrhage (five). Patients who presented CNS complication s had a higher mortality rate than those who did not (55% versus 17%, p = 0.002). Multiple logistic regression analysis showed abnormal pret ransplant neurologic examination suggestive of chronic hepatic encepha lopathy (p = 0.007) and noncholestatic liver disease (p = 0.012) to be independently associated with in-hospital CNS complications. These da ta indicate that CNS neurologic complications following liver transpla nt are common in patients with noncholestatic liver disease and are as sociated with increased mortality. The pretransplant neurologic examin ation is an important predictor of CNS complications that occur in the immediate post-transplant period.