الفهرس 
Neurological complications of liver transplantationOnly 14 pages are availabe for public view
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Abstract
Live donor liver transplant is a surgical procedure performed to replace a diseased liver with a healthy one from another living person. Family members or individuals who are unrelated but make a good match may be able to donate a portion of their liver. Individuals who donate a portion of their liver can live healthy lives with the remaining liver. Outcome of patients undergoing LT has improved substantially because of better preservation of donor livers and surgical advances such as venovenous bypass, refinements in biliary reconstruction, and improvement in current immunosuppressive regimens. Despite these advances, neuropsychiatric complications are an important cause of morbidity and mortality in patients receiving LT and are a challenge for both the transplant surgeon and the neuropsychiatrist. Liver transplantation is the only curative treatment in patients with end- stage liver disease. The aim of this study was to detect the occurrence of neuropsychiatric complications after liver transplantation and to identify any possible relationship between these complications and certain perioperative risk factors. The study was performed on 35 patients, aged 29 to 50 years old, twenty males and fifteen females, admitted to the unit of liver transplant surgery, National liver institute, Menoufiya university, underwent live donor liver transplant from April 2013 to May 2014, patients were assessed two weeks preoperatively and followed up for three months post operatively. Regarding the etiology for transplantation, the most common causes were hepatitis C virus ESLD (25.7%) followed by HBV (22.9%), HCC (20%), FHF (11.4%), alcoholic cirrhosis (5.7%), primary S.C (5.7%), primary B.C (5.7%) and hepatic artery stenosis (2.9%). Pediatric patients (age <18 years), patients with significant psychiatric disorders that fail to be under excellent medical control, patients with known neurological deficits, and medical conditions which may significantly impair the ability of an individual to consent to transplantation have been excluded. Postoperative neurological complications were detected in 13 patients (37.1%) in the form of central complications; of which encephalopathy was the most common (20%) followed by seizures (17.1%), cerebral hemorrhage (5.7%), cerebral infarction (2.9%), and peripheral complications; common peroneal neuropathy (5.7%) and ulnar neuropathy (2.9%). This study detected no significant relationship between the incidence of NCs and primary liver diagnosis in LDLT. Preoperative encephalopathy (p=0.002), preoperative electrolyte imbalance (p=0.006) showed statistical significance for patients with postoperative encephalopathy. This study showed statistical significance regarding preoperative electrolyte imbalance (p=0.02), immunosuppressants (p=0.04) for patients with post operative seizures There was statistical significance regarding HTN (p=0.05) for patients with cerebral hemorrhage. Age (p=0.05), AF (p=0.006) and carotid stenosis ≥50% (p=0.000) showed statistical significance for patients with postoperative infarction. Post-operative psychiatric complications were detected in 15/35 patients (42.8%), in the form of cognitive disorders (4 patients) (11.4%), adjustment disorder 4 patients (11.4%), depressive disorders 3 patients (8.6%), anxiety disorders 3 patients (8.6%) and lastly one patient with brief psychotic episode (2.9%).The prevelance of depression for hepatitis C patients was (55.6%) and for other primary liver diseases was (3.8%), DM (p=0.05), preoperative electrolyte disturbance (0.05) and preoperative encephalopathy (p=0.04) showed statistical significance for patients with postoperative cognitive disorders. This study failed to show any difference between the type of immunosuppressant and the presence of neuropsychiatric complications.