Otan Emrah, Aydin Cemalettin, Yönder Hüseyin, Kayaalp Cüneyt, Kaplan Yüksel, Yilmaz Sezai
Department of General Surgery and Institute for Liver Transplantation, Inönü University Faculty of Medicine, Malatya, Turkey.
Department of Neurology, Inönü University Faculty of Medicine, Malatya, Turkey.
Noro Psikiyatr Ars. 2015 Mar;52(1):15-18. doi: 10.5152/npa.2015.7226. Epub 2015 Mar 1.
Liver transplantation is one of the best treatment options for end-stage liver disease. In Turkey, living donor liver transplantation (LDLT) is performed more frequently than cadaveric transplantation, because organ donation is unpopular in our country. Neurological complications contribute to poor postoperative outcomes after liver transplantation. In the present study, we aimed to evaluate the outcomes of LDLT patients in whom such complications developed early during postoperative follow-up in the intensive care unit.
Of 217 LDLTs performed between August 2011 and August 2012, neurology consultations were arranged for 29 patients (13.36%) because of development of new-onset neurological symptoms and/or findings in patients with neurologically uneventful preoperative histories. We retrospectively collected data on age, gender, primary disease, Model for End-Stage Liver Disease (MELD) score, and postoperative hospitalization duration of those who survived. The indications for neurological consultation and diagnoses were categorized into acute confusion/encephalopathy, epileptic seizures, leukoencephalopathy, and focal neurological deficits. The immunosuppressive treatment regimens prescribed were also considered. The outcomes of the 2 groups (with and without neurological complications) were compared.
The mean patient age was 44.52±16.24 years, and males predominated (65.5%, n=19). Acute confusion/encephalopathy was the most frequent complication (62.1%, n=18), followed by epileptic seizures (27.6%, n=8), cerebrovascular disease (6.9%, n=2), and leukoencephalopathy (3.4%, n=1). Statistically significant between-group differences in age (44.5±16.2 vs. 34.33±20.98 years; p<0.001), and proportions of patients with a disease of viral etiology (55.17% vs. 35.63%, p<0.05), were evident. Mortality was significantly higher in the group with neurological complications (65.5% vs. 37.32%, p<0.05). The duration of postoperative hospitalization was also significantly longer in this group (29.80±15.04 vs. 10.00±5.47 days; p<0.05).
Mortality was significantly higher and the duration of postoperative hospitalization significantly longer in LDLT patients with new-onset neurological complications than in those without such complications.
肝移植是终末期肝病最佳治疗选择之一。在土耳其，活体供肝肝移植（LDLT）的实施频率高于尸体肝移植，因为在我国器官捐献不受欢迎。神经并发症会导致肝移植术后预后不良。在本研究中，我们旨在评估在重症监护病房术后早期出现此类并发症的LDLT患者的预后情况。
在2011年8月至2012年8月期间实施的217例LDLT中，有29例（13.36%）患者因术前无神经病变病史但出现新发神经症状和/或体征而安排了神经科会诊。我们回顾性收集了存活患者的年龄、性别、原发性疾病、终末期肝病模型（MELD）评分及术后住院时间的数据。神经科会诊的指征和诊断分为急性意识模糊/脑病、癫痫发作、白质脑病和局灶性神经功能缺损。还考虑了所开具的免疫抑制治疗方案。比较了两组（有和无神经并发症）的预后情况。
患者平均年龄为44.52±16.24岁，男性居多（65.5%，n = 19）。急性意识模糊/脑病是最常见的并发症（62.1%，n = 18），其次是癫痫发作（27.6%，n = 8）、脑血管疾病（6.9%，n = 2）和白质脑病（3.4%，n = 1）。年龄（44.5±16.2岁 vs. 34.33±20.98岁；p<0.001）以及病毒病因疾病患者比例（55.17% vs. 35.63%，p<0.05）在组间存在统计学显著差异。有神经并发症组的死亡率显著更高（65.5% vs. 37.32%，p<0.05）。该组术后住院时间也显著更长（29.80±15.04天 vs. 10.00±5.47天；p<0.05）。
新发神经并发症的LDLT患者的死亡率显著更高，术后住院时间显著更长，高于无此类并发症的患者。
