To describe the frequency of neurological complications in patients with liver transplantation and their association with different clinical variables.

Neurological complications affect 15-47% of the patients after liver transplantation (LT). Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections. There is limited information from Latin America regarding neurological complications in LT patients.

We performed a retrospective study including all LT patients from January 2010 to December 2014 at the Hospital Británico de Buenos Aires. We analyzed previous liver disease, type of transplant received, immunosuppressant agents used, neurological complication observed and time to symptom onset after the transplant. Categorical variables were expressed in percentages and numerical variables as mean and standard deviation (SD). Fisher and Mann-Whitney tests were used for the statistical analysis. A p<0.05 (two-tailed test) was considered significant.

Seventy-six patients with LT were evaluated, 38% (n=29) presented neurological complications. Of these, 69% (n=20) were men, with a mean age of 58 years (SD: 13, range: 20-74 years). The most frequent diseases leading to LT were hepatitis C virus infection (27%, OR: 0.67 (0.24-1.84), p=0.302) and alcohol-related disease (20%). In 92% of the cases, LT was orthotopic from a cadaveric donor. The commonest immunosuppressive medication used was tacrolimus (93%). Patients with neurological complications had higher tacrolimus doses (13 vs 2.4 mg, p=0.024). Other immunosuppressants used alone or in combination were: mycophenolate (25%) and everolimus (12%). Neurological complications: seizures (28%) and headache (20%). Mean time from symptom onset to LT: 2.8 years (range: 1 day - 10 years).

In our LT cohort, neurological complications were common, with seizures being the most frequent. Higher tacrolimus serum levels may predispose patients to develop neurotoxicity. Physicians should be aware of the high risk of these complications after LT.