Neurological Complications of Orthotopic Liver Transplantation

Abstract

L iver transplantation is a lifesaving procedure for the treatment of end-stage liver diseases. Since the first successful liver transplantation by Dr Starzl in 1963, there has been tremendous and dynamic progress of surgical and postoperative protocols leading to 1-year and 5-year post transplant survival rates at 88% and 74%, respectively. However, a variety of post-transplant complications, which may not be directly related to allograft function, complicate recovery of transplant recipients. Neurologic complications are still fairly common after solid organ transplantation and affect 30%-60% of allograft recipient, including 15%-30% of liver allograft recipients. Major neurologic complications include alterations of consciousness, seizures, cerebrovascular complications and central nervous system (CNS) infections, similarly as with other solid organ transplants, and also central pontine myelinolysis (CPM) which is characteristic for liver transplantation. Pre-transplant liver failure may be associated with various neurologic complications directly related to liver dysfunction (e.g., hepatic encephalopathy), or related to systemic disorders associated with major neurologic manifestations (e.g., Wilson’s disease). Stabilization of liver function following successful transplantation may subsequently lead to improvement of neurologic symptoms as well. During the post-transplant clinical course, the surgical procedure of transplantation, chronic immunosuppression and various toxic-metabolic disorders may precipitate a wide spectrum of neurologic complications.