https://pubmed.ncbi.nlm.nih.gov/35959774/ Transplant
Pediatr Transplant. 2022 Aug 12;e14376.
doi: 10.1111/petr.14376. Online ahead of print.

Neurological complications in pediatric liver transplant recipients

Jagadeesh Menon 1, Naresh Shanmugam 1, Ashwin Rammohan 2, Abdul Hakeem 2, Mettu Srinivas Reddy 2, Mohamed Rela 2
Affiliations expand
PMID: 35959774

DOI: 10.1111/petr.14376

Abstract

Introduction: There is paucity of data on neurological complications (NCs) and its predisposing factors, in pediatric liver transplant (PLT) recipients.
Methods: Records of seventy-one children who underwent LT between October 2018 and November 2019 were reviewed. Patients were categorized into group A: with NC and group B: without NC in the post-LT period. Various risk factors contributing to NC were studied.

Results: In total, 15 (21.1%) had NC (group A) and 56 (78.9%) had no NC in the post-LT period. NC included cerebrovascular accident (n = 1), seizures (n = 5; 4 generalized, 1 focal), central pontine myelolysis (CPM) (n = 1), diaphragmatic palsy (n = 2), peripheral neuropathy (n = 1), extrapyramidal movements (n = 3), and encephalopathy beyond 96 h (n = 2). The median onset of NC was at 8.5 days post-LT (1-58 days). Ten (66.7%) patients in group A had grades 2-4 hepatic encephalopathy (HE) prior to LT. Eight (14.3%) patients in group B also had pre-LT neurological issues including HE in six, epilepsy and spastic diplegia in one each. On univariate analysis, pre-existing HE, high PELD/MELD score, pre-LT ventilation, pre-LT infection, higher day 1 post-operative bilirubin (all p < .05), and higher tacrolimus were found to predict post-operative NC whereas on multivariate analysis, pre-LT HE was the only predictive factor. Median follow-up was 15.5 months. Four patients died in each group (survival log-rank p = .369). All the surviving patients in group A (n = 11) fully recovered from the NC.

Conclusion: Pre-transplant HE was the single most significant predisposing factor for post-LT neurological complications