Postoperative neurological complications in 185 patients who underwent two or more orthotopic liver transplantations were reviewed. The most common neurological complications were alteration of mental status (84%), seizures (33%) and focal motor deficits (16%). The frequency of neurological complications after a second orthotopic liver transplantation was significantly greater than that after a single orthotopic liver transplantation. However, neurological complications were more frequent after a second orthotopic liver transplantation than after a third transplant. Significantly more neurological complications occurred in patients who did not survive a year than in those who did, regardless of the number of transplants they underwent. These findings indicate that the risk of neurological complications among patients with multiple orthotopic liver transplantations is greater in those who require a second transplane this risk appears to diminish after a third transplant. Importantly, the presence of neurological complications is asso- ciated with increased post-orthotopic liver transplantation mortality rate. (HEPATOLOGY 1992;16162-166.) Since the first orthotopic liver transplantation (OLT) was performed in 1963 (11, substantial changes in the surgical technique and in the immunosuppressive therapy used have improved the results of this procedure. Typically, patients whose initial transplants fail undergo additional transplants in an effort to save their lives.
Neurological complications are common in OLT recipients. These complications include encephalopathy, seizures, intracranial hemorrhage, cerebral infarctions, central pontine myelinolysis and meningoencephalitis and abscesses caused by opportunistic infections (2-9). Drug-related neurological complications can also occur, especially with the use of the more recently introduced immunosuppressive agents such as cyclosporine (CYA)