Neurological complications in pediatric liver transplant recipients.

Abstract

There is paucity of data on neurological complications (NCs) and its predisposing factors, in pediatric liver transplant (PLT) recipients. 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. 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. Pre-transplant HE was the single most significant predisposing factor for post-LT neurological complications.