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Lening C, Agopian VG, Busuttil RW, et al. Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation. Neurohospitalist. 2017;8(3):124-128doi: 10.1177/1941874417738689.
Lening, C., Agopian, V. G., Busuttil, R. W., & Liebeskind, D. S. (2018). Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation. The Neurohospitalist, 8(3), 124-128. https://doi.org/10.1177/1941874417738689
Lening, Christopher, et al. "Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation." The Neurohospitalist vol. 8,3 (2018): 124-128. doi: https://doi.org/10.1177/1941874417738689
Lening C, Agopian VG, Busuttil RW, Liebeskind DS. Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation. Neurohospitalist. 2018 Jul;8(3):124-128. doi: 10.1177/1941874417738689. Epub 2017 Nov 07. PMID: 29977442; PMCID: PMC6022898.
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Neurohospitalist. 2018 Jul;8(3):124-128. doi: 10.1177/1941874417738689. Epub 2017 Nov 07.

Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation.

The Neurohospitalist

Christopher Lening, Vatche G Agopian, Ronald W Busuttil, David S Liebeskind

Affiliations

  1. Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
  2. Division of Liver Transplantation, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.

PMID: 29977442 PMCID: PMC6022898 DOI: 10.1177/1941874417738689

Abstract

BACKGROUND: We examined neurologic consultations for altered mental status in perioperative liver transplant patients to determine the overall incidence, to assess the presumed etiology and the data reviewed to determine that etiology, and to assess outcomes.

METHODS: Retrospective chart review conducted for all 728 adult patients receiving orthotopic liver transplantation (OLT) between January 01, 2010, to June 30, 2014, with identification of 218 receiving neurology consults between 30 days pre-OLT and 90 days post-OLT, with review of all records necessary to determine initial findings and follow-up examination.

RESULTS: Seventy-three consults for 69 patients were identified, with 27 felt to be altered since a procedure, 20 with sudden-onset altered mentation, and 26 with gradual or waxing-waning course. A single underlying etiology was identified in only 19 cases, with multiple factors involved in all others, with metabolic, toxic, infectious, and structural etiologies most often implicated. There was no statistically significant difference in outcome for those with altered mental status consults versus the total OLT population, though the sudden-onset presentation group did show significantly increased mortality rates.

CONCLUSIONS: This systematic study illustrates the variety of potential causes of altered mentation within the perioperative setting of liver transplantation. Workup including neuroimaging (preferably magnetic resonance imaging), infectious cultures, and expanded metabolic laboratory tests should be undertaken.

Keywords: brain diseases; hepatic encephalopathy; metabolic; outcomes; techniques

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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