Neurological complications are responsible for significant mortality and morbidity after orthotopic liver transplantation. They are reported in 8.3 to 47% of cases in different series. This prospective study was performed to investigate the prevalence and characteristics of neurological complications in the first 100 patients who undergone orthotopic liver transplantation since 1993 to 2004 in Nemazee hospital, Shiraz, south of Iran. Neurological symptoms and signs, routine laboratories, drug levels, virologic and serologic studies, brain CT scans and MRIs and electrodiagnostic studies were investigated. Follow-up period was between 2 months to 10 years.
19 out of 100 patients (14 men and 5 women) developed neurological complications with the average age of 34.9+/-16.3. The most common symptoms and signs were abnormal behaviour (52.6%), decreased level of consciousness (47.4%), extrapyramidal manifestations (42.1%), convulsions (26.3%), and anxiety and depression (21%). The most common neurological syndromes were hepatic encephalopathy (31.6% of neurological patients), drug toxicity (26.2%), electrolyte imbalance (10.5%), uremic encephalopathy (5.2%), delayed operation recovery (10.5%), hypoxic brain damage (5.2%). In 10.5% of cases we can't find any determined cause for neurological presentations. Comparing to other centres, neurological complications were relatively less common in our centre. Change in the level and content of consciousness were the most common findings and hepatic encephalopathies was the most common cause. There are many confounding factors for finding of the exact ethiopathogenesis of neurological complications of liver transplantation.