Acute confusional state following liver transplantation for alcoholic liver disease.

BACKGROUND: Neurologic complications occur in 10% to 20% of patients after liver transplantation.

OBJECTIVE: To assess postoperative neurologic complications in relation to increased use of liver transplantation for alcoholic liver disease.

METHODS: Neurologic complications in 40 patients who received liver transplantation for alcoholic liver disease were compared with those in 47 patients who had transplantation for hepatitis C. All patients were older than 50 years and received transplants between 1990 and 2000.

RESULTS: Acute confusion for 3 or more days occurred in 48% of the patients with alcoholic liver disease but in only 6% of those with hepatitis C (p < 0.0001). Neurotoxicity related to calcineurin inhibitor medication occurred in 7% of the alcohol group and 15% of the hepatitis C group (p = 0.33). Critical illness polyneuropathy and myopathy were noted in 10% of the patients with alcoholism and 2% of the patients with hepatitis C (p = 0.18). A shorter duration of sobriety within the alcohol group was associated with acute confusional state (p = 0.02). An increased preoperative level of ammonia in serum was a risk factor for post-transplantation acute confusional state (p = 0.001). Patients with postoperative acute confusional state had a longer hospital stay (p = 0.0002).

CONCLUSIONS: An acute confusional state occurred in more than half the patients with transplantation for alcoholic liver disease. Increased pretransplantation serum level of ammonia and shorter duration of sobriety were risk factors in these patients.