Central nervous system complications in liver transplant recipients - incidence, timing, and long-term follow-up

Background: Neurological impairment is a major source of morbidity and mort ality following orthotopic liver transplantation (OLT). We reviewed our exp erience with neurologic complications among our first 463 consecutive adult OLT recipients. Methods: Between September 1988 and October 1993, 463 adult patients underw ent OLT. Data on incidence, time of onset, and outcome of central nervous s ystem (CNS) complications was obtained from patient charts, including autop sy results when available. CNS complications were classified by clinical pr esentation and by etiology. Results: 93 patients (20.1%) had CNS complications following OLT. Encephalo pathy (11.8%) and seizure (8.2%) were the leading complications. The incide nce of immunosuppressive drug-related complications was 5.6%, coma, 1.7%; c erebral hemorrhage, 1.5%; central pontine myelinolysis (CPM), 1.2%; stroke, 0.6%; and primary CNS lymphoma, 0.2%. Most CNS events (80%) were encounter ed in the first month after OLT. In the majority of cases, encephalopathy ( 70%) and seizure (50%) presented in the first 2 wk. Although most CNS infec tions occurred early, 2 patients developed tuberculous meningitis more than 1 yr post-OLT. In 12 patients, death was directly related to CNS complicat ions (2.6%). Conclusions: Most CNS complications occur early following OLT but may be se en even after 1 yr. Patients may survive serious neurologic events, such as cerebral hemorrhage, CPM, and meningitis.