Comprehensive risk assessment for early neurologic complications after liver transplantation
Journal
World Journal of Gastroenterology
Journal Volume
22
Journal Issue
24
Pages
5548-5557
Date Issued
2016
Author(s)
Abstract
AIM: To determine risk factors for early neurologic complications (NCs) after liver transplantation from perspective of recipient, donor, and surgeon. METHODS: In all, 295 adult recipients were enrolled consecutively between August 2001 and February 2014 from a single medical center in Taiwan. Any NC in the first 30 d post-liver transplantation, and perioperative variables from multiple perspectives were collected and analyzed. The main outcome was a 30-d NC. Generalized additive models were used to detect the non-linear effect of continuous variables on outcome, and to determine cut-off values for categorizing risk. Risk factors were identified using multiple logistic regression analysis. RESULTS: In all, 288 recipients were included, of whom 142 (49.3%) experienced at least one NC, with encephalopathy being the most common 106 (73%). NCs prolonged hospital stay (35.15 ± 43.80 d vs 20.88 ± 13.58 d, P < 0.001). Liver recipients' age < 29 or = 60 years, body mass index < 21.6 or > 27.6 kg/m2, Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/mL, and postoperative intraabdominal infection were more likely associated with NCs. Novel risk factors for NCs were donor age < 22 or ? 40 years, male-to-male gender matching, graftrecipient weight ratio 0.9%-1.9%, and sequence of transplantation between 31 and 174. CONCLUSION: NCs post- liver transplantation occurs because of factors related to recipient, donor, and surgeon. Our results provide a basis of risk stratification for surgeon to minimize neurotoxic factors during transplantation. ? The Author(s) 2016.
Subjects
Donor; Learning curve; Liver transplantation; Neurotoxicity syndromes; Risk
SDGs
Other Subjects
tacrolimus; corticosteroid; immunosuppressive agent; mycophenolic acid; tacrolimus; abdominal infection; acute graft rejection; acute kidney failure; adult; alcohol liver disease; Article; body mass; brain disease; central pontine myelinolysis; cerebrovascular disease; Child Pugh score; controlled study; cytomegalovirus infection; delirium; female; graft failure; graft recipient; hepatic encephalopathy; hepatitis B; hepatitis C; hospitalization; human; liver cell carcinoma; liver transplantation; locked in syndrome; major clinical study; male; mental disease; middle aged; multivariate logistic regression analysis; neurologic disease; organ donor; outcome assessment; perioperative period; psychosis; risk assessment; seizure; surgeon; Taiwan; tuberculosis; age; blood; Brain Diseases; case control study; chemically induced; Consciousness Disorders; delirium; donor; graft rejection; hepatic encephalopathy; Intraabdominal Infections; length of stay; Mental Disorders; Myelinolysis, Central Pontine; Neurotoxicity Syndromes; Posterior Leukoencephalopathy Syndrome; Postoperative Complications; preoperative period; Psychotic Disorders; risk assessment; risk factor; Seizures; sex difference; statistics and numerical data; Stroke; Adrenal Cortex Hormones; Adult; Age Factors; Body Mass Index; Brain Diseases; Case-Control Studies; Consciousness Disorders; Delirium; Female; Graft Rejection; Hepatic Encephalopathy; Humans; Immunosuppressive Agents; Intraabdominal Infections; Length of Stay; Liver Transplantation; Male; Mental Disorders; Middle Aged; Mycophenolic Acid; Myelinolysis, Central Pontine; Neurotoxicity Syndromes; Posterior Leukoencephalopathy Syndrome; Postoperative Complications; Preoperative Period; Psychotic Disorders; Risk Assessment; Risk Factors; Seizures; Sex Factors; Stroke; Tacrolimus; Taiwan; Tissue Donors
Type
journal article