Graft factors as determinants of postoperative delirium after liver transplantation

D Patrono,P Berchialla,R Romagnoli,L Giordanengo,S Skurzak,F Rigo,S Bormida,R Balagna

doi:10.1007/s13304-020-00887-3

Abstract

Post-operative delirium (POD) is a frequent complication after surgery, occurring in 15–20% of patients. POD is associated with a higher complications rate and mortality. Literature on POD after liver transplantation (LT) is limited, with the few available studies reporting an incidence of 10–47%. The aim of this study was analyzing pattern, risk factors and clinical impact of POD after LT. Data on donor and recipient characteristics, postoperative course and POD of consecutive adult LT recipients from March 2016 to May 2018 were prospectively collected and retrospectively analyzed. Risk factors for POD were analyzed using univariable logistic regression and Lasso regression. Kaplan–Meier method was used for survival analysis. 309 patients underwent LT during study period; 3 were excluded due to perioperative death. Incidence of POD was 13.4% (n = 41). The median day of onset was 5th (IQR [4–7]) with a median duration of 4 days (IQR [3–7]). Several risk factors, related to the severity of liver disease and graft characteristics, were identified. Graft macrovesicular steatosis was the only factor independently associated with POD at multivariable analysis (OR 1.27, CI 1.09–1.51, p = 0.003). POD was associated with a higher rate of severe postoperative complications and longer intensive care unit and hospital stay, but did not significantly impact on patient and graft survival. Incidence of POD after LT is comparable to that observed after general surgery and graft factors are strongly associated with its onset. These results help identifying a subset of patients to be considered for preventive interventions.

Highlights

Post-operative delirium (POD) is one of the most common postoperative complications
It has been suggested that pathogenesis of POD presenting after liver transplantation (LT) is multifactorial: infections, organ failure, encephalopathy and neurotoxicity of immunosuppressants have all been called into question
Diagnosis of POD was based on confusion assessment method (CAM) [17, 18] and was confirmed by a senior member of our dedicated team of transplant psychologists and psychiatrists who are in charge of pre-LT assessment and post-LT follow-up

Summary

Introduction

Post-operative delirium (POD) is one of the most common postoperative complications. Delirium can be defined as a transient, mostly reversible organic-mental syndrome that includes confusion, cognitive impairment, decline of vigilance, increased or reduced psychomotor activity and Limited data are available about POD in the setting of liver transplantation (LT). Knowledge on POD gathered in the general surgical population might not. It has been suggested that pathogenesis of POD presenting after LT is multifactorial: infections, organ failure, encephalopathy and neurotoxicity of immunosuppressants have all been called into question. Previous studies have linked POD to the use of antidepressant drugs before surgery, history of pre-LT portosystemic encephalopathy, alcohol abuse, retransplantation or high APACHE II score [10, 11, 13,14,15,16]

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