Neuropsychiatric complications after liver transplantation

Mohamad Ezzat Amin¹, Faisal Abd El-Wahab Atta^2
1 Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt
² Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence Address:
Mohamad Ezzat Amin
Associate Professor of Psychiatry, Faculty of Medicine, Cairo University, 11112 Cairo
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.7123/01.EJP.0000413631.81234.45

The aim of this retrospective study was to evaluate the incidence of neuropsychiatric complications (NPCs) after living donor liver transplantation.

Between May 2001 and April 2005, 110 recipients were admitted to the ICU after liver transplantation (LT) and were evaluated by full general, psychiatric, and neurological examinations, electroencephalography, and brain computed tomography and/or MRI. Diagnosis of psychiatric disorders was made according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision criteria, and the presence or absence of paradoxical psychiatric syndrome (PPS) was evaluated on the basis of the diagnostic criteria for PPS. Patients were observed after LT for 1 year.

Of the patients who underwent transplantation, 50.9% developed NPCs and these patients’ stay in the ICU was much longer than that of all admitted patients. Neurological complications were observed in 32.7% of patients and psychiatric disorders in 43.6%, of which 62.5% developed PPS. The survival rate after LT of patients with NPCs was similar to that of patients without NPCs. The incidence of neuropsychiatric symptoms was found to be similar between patients treated with cyclosporine and those treated with tacrolimus. Finally, no correlation was observed between the primary cause of liver disease and the NPCs reported.

There was a high incidence of NPCs after LT, prolonging the patients’ stay in intensive care significantly. Careful preoperative and postoperative neuropsychiatric evaluations are important for early diagnosis of NPCs.