Early severe neurological complications after pediatric liver transplantation: a report of 15 patients / 中华肝胆外科杂志

ABSTRACT

Objective:To study the clinical course and underlying causes of early severe neurological complication (ESNC) after pediatric liver transplantation.Methods:A retrospective study was conducted on 309 pediatric liver transplantation recipients treated at Tianjin First Central Hospital from January 2018 to December 2018. ESNC occurred in 15 patients (4.8%, 15/309) within 1 month after liver transplantation. There were 7 males and 8 females, aged from 6 to 46 months. Liver transplantation was carried out for biliary atresia ( n=12), fulminant liver failure ( n=1), Niemann-Pick disease ( n=1) and Alagille syndrome ( n=1). The causes of ESNC and the prognosis were analyzed. Results:The onset of ESNC was 10.7 (0-28) d after liver transplantation. Twelve patients developed encephalopathy with epilepsy in 2 patients. Four of these patients were caused by severe infection, 4 by heart failure combined with respiratory failure which led to ischemic hypoxic encephalopathy, 2 by transplant liver failure, 1 by intracranial infection, and 1 by severe brain swelling which led to brain death. Epilepsy occurred in 3 patients, 2 caused by neurotoxicity of calcineurin inhibitors, and 1 caused by reversible posterior leukoencephalopathy syndrome. Three children with ESNC died after operation, including 1 brain death, 1 due to severe heart failure and 1 due to severe infection.Conclusions:ESNC occurred in 4.8% of patients which seriously affected long-term prognosis of patients. Measures to reduce the incidence of ESNC include prevention of postoperative infection and drug toxicity, and good control of cardiac insufficiency.