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Neurological Complications Following Pediatric Liver Transplant

Ghosh, Partha S.*; Hupertz, Vera; Ghosh, Debabrata*

Journal of Pediatric Gastroenterology & Nutrition: April 2012 - Volume 54 - Issue 4 - p 540–546
doi: 10.1097/MPG.0b013e3182407de3
Original Articles: Hepatology and Nutrition

Objective: We studied neurological complications (NCs) after liver transplantation (LT) in children.

Methods: We performed an institutional review board–approved retrospective review of patients with LT ≤21 years during a period of 30 years (1980–2010). NCs were classified as early (within 3 months post-LT) and delayed (beyond 3 months post-LT).

Results: Of 65 children with LT, 20 (30.7%) had NCs; 16 were girls. Mean age was 11.8 ± 5.9 years. Early NCs were found in 13.8% (9/65) of the patients: seizures in 7 and encephalopathy in 2. Abnormal neuroimaging findings were posterior reversible leukoencephalopathy syndrome (1), intracranial hemorrhage (1), mild cerebral edema (1), and bilateral basal ganglia T1W hyperintensities in magnetic resonance imaging (1). On follow-up, there were 3 deaths (unrelated to NCs). One with intracranial hemorrhage had residual hemiparesis and was taking a long-term antiepileptic drug. Late NCs are found in 16.9% (11/65) of the patients: seizures in 4, headache in 4, encephalopathy in 3 (1 had seizures in addition), and paresthesias caused by possible small-fiber neuropathy in 1. Abnormal neuroimaging findings were hypoxic-ischemic encephalopathy (1), encephalomalacia caused by old hemorrhage (1), and hyperintensity of the posterior periventricular white matter in magnetic resonance imaging (1). On follow-up, all of the patients survived; 1 had papilledema with secondary optic atrophy requiring optic nerve sheath fenestration and 1 needed long-term antiepileptic drug.

Conclusions: NCs are common in children after LT, seizures being the most common. In contrary to the previous studies, we found delayed complications more often than early complications. Early detection and appropriate management of NCs is important.

*Pediatric Neurology Center

Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH.

Address correspondence and reprint requests to Debabrata Ghosh, MD, Desk S 60, Child Neurology Center, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (e-mail:

Received 20 June, 2011

Accepted 28 October, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN