Neurological complications following liver transplantation

17 (33%) of 52 patients who underwent 56 consecutive orthotopic liver transplants had serious neurological complications postoperatively. The commonest complication was fits, which occurred in 13 (25%) patients. 50% of patients had their onset of fits within the first week. In 3 patients the fits were associated with postoperative metabolic encephalopathy and fatal progressive neurological deterioration. In some patients the evidence implicating cyclosporin in the development of fits is strong. In others factors such as electrolyte disturbances, steroid treatment for graft rejection, and cerebral infarction may have contributed to the development of the fits. Phenytoin controlled the fits in 10 out of 13 patients. Other neurological complications included 1 case of central pontine myelinolysis, 1 of cerebral abscess, and 4 of non-encephalopathic psychosis.