[Predictive factors of neurological complications in the period immediately after liver transplant: experiences in the Centro de Investigaciones Médico Quirúrgicas in Cuba]. / Factores predictivos de las complicaciones neurológicas en el postrasplante hepático inmediato: experiencia en el Centro de Investigaciones Médico Quirúrgicas de Cuba.

INTRODUCTION: Liver transplant (LT) is today a first choice procedure in a group of hepatic diseases in their acute and chronic terminal stages. It is not, however, a technique that is completely free of complications and those of a neurological nature constitute between 8 47% of those reported. AIMS. The purpose of this study is to present the immediate neurological complications (NC) found in our patients, as well as to determine the predictive factors and their relation to the mortality rate. PATIENTS AND METHODS: From the medical records of 26 patients who received LT at the CIMEQ (July 1999 December 2001), we collected a group of variables related to the donor, the surgical procedure and the post operative period and associated them to the occurrence of NC while these patients were in the ICU. RESULTS: NC were found in 16 patients (61.5%), the most frequent being encephalopathy (30.8%), tremor (26.9%), and convulsions (19.2%). No relation was found between the presence of NC and prior hepatic encephalopathy, the use of a suboptimal donor, nor did it represent a significant increase in the mortality rate. There was a significant relation with LT to recipients rated as grade C on the Child Pugh classification system, the presence of intraoperative hypotension (p= 0.0164) and primary dysfunction of the liver graft (p= 0.041). CONCLUSIONS: NC represented a significant cause of morbidity in the period following a liver transplant in our series, although they had no significant repercussion on the mortality rate. Their presence is related to variables concerning the recipient, the surgical procedure itself and the immediate post operative period.

Factores predictivos de las complicaciones neurológicas en el postrasplante hepático inmediato: experiencia en el Centro de Investigaciones Médico Quirúrgicas de Cuba / Predictive factors of neurological complications in the period immediately after liver transplant: experiences in the centro de investigaciones médico quirúrgicas in cuba

Introducción. El trasplante hepático (TH) es hoy en día un procedimiento de elección en un grupo de enfermedades hepáticas agudas y crónicas en estadio terminal. Sin embargo, no es una técnica exenta de complicaciones; las neurológicas se comunican entre el 8 y el 47 por ciento. Objetivos. Presentar las complicaciones neurológicas (CN) inmediatas encontradas en nuestros pacientes, así como determinar los factores predictivos y su relación con la mortalidad. Pacientes y métodos. De los expedientes clínicos de los 26 pacientes que fueron tributarios de TH en el CIMEQ (julio 1999-diciembre 2001), se recogió un grupo de variables relacionadas con el donante, el acto quirúrgico y el posoperatorio, y se relacionó con la presencia de CN durante su estancia en la UCI. Resultados. Encontramos CN en 16 pacientes (61,5 por ciento); las más frecuentes fueron la encefalopatía (30,8 por ciento), temblores (26,9 por ciento), y convulsiones (19,2 por ciento). No se encontró relación entre la presencia de CN, y encefalopatía hepática previa o con uso de donante subóptimo, ni representó un aumento significativo en la mortalidad. Existió una relación significativa con el TH a receptores grado C de la clasificación de Child-Pugh, la presencia de hipotensión intraoperatoria (p = 0,0164), y de disfunción primaria del injerto hepático (p = 0,041). Conclusiones. En nuestra serie, las CN representaron una morbilidad significativa en el postrasplante hepático, sin repercusión significativa en la mortalidad. Su presencia se relaciona con variables del receptor, del acto operatorio y del posoperatorio inmediato (AU)

Introduction. Liver transplant (LT) is today a first choice procedure in a group of hepatic diseases in their acute and chronic terminal stages. It is not, however, a technique that is completely free of complications and those of a neurological nature constitute between 8-47% of those reported. Aims. The purpose of this study is to present the immediate neurological complications (NC) found in our patients, as well as to determine the predictive factors and their relation to the mortality rate. Patients and methods. From the medical records of 26 patients who received LT at the CIMEQ (July 1999-December 2001), we collected a group of variables related to the donor, the surgical procedure and the post-operative period and associated them to the occurrence of NC while these patients were in the ICU. Results. NC were found in 16 patients (61.5%), the most frequent being encephalopathy (30.8%), tremor (26.9%), and convulsions (19.2%). No relation was found between the presence of NC and prior hepatic encephalopathy, the use of a suboptimal donor, nor did it represent a significant increase in the mortality rate. There was a significant relation with LT to recipients rated as grade C on the Child-Pugh classification system, the presence of intraoperative hypotension (p= 0.0164) and primary dysfunction of the liver graft (p= 0.041). Conclusions. NC represented a significant cause of morbidity in the period following a liver transplant in our series, although they had no significant repercussion on the mortality rate. Their presence is related to variables concerning the recipient, the surgical procedure itself and the immediate post-operative period (AU)