Validated Score for Prediction of Neurological Complications After Living Donor Liver Transplant.

Objectives: Neurological complications after liver transplant greatly increase patient mortality and morbidity. Our study aimed to assess the prevalence and risk factors associated with neurological complications after liver transplant and to investigate the possibility of creating a predictive model to identify patients more likely to develop these complications.

Materials and methods: After Institutional Ethics Committee approval, researchers prospectively gathered data on patients who received living donor liver transplant at the Dr. Rela Institute and Medical Centre in Chennai, India, from January 2019 to September 2022. We examined perioperative factors to identify risk factors and evaluated outcomes of interventions in cases involving neurological complications.

Results: Among 569 liver transplant recipients, 42 (7.4%) developed neurological complications. Complications included altered sensorium, convulsions, localized neurological deficits, posterior reversible encephalopathy syndrome, and intracranial hemorrhage. Using logistic regression analysis, we identified several independent factors that predicted neurological complications afterlivertransplant.These factors (odds ratio; 95% CI) were preoperative Model for End-Stage LiverDisease score (1.76; 95% CI, 1.05-2.93), preexisting hepatic encephalopathy (2.49; 95% CI, 1.16-5.33), requirement for vasopressor support for >24 hour from end of surgery (3.08; 95% CI, 1.25-7.58), postoperative sepsis (3.55; 95% CI, 1.51-8.34), early allograft dysfunction (5.37; 95% CI, 2.23-12.93), and duration of intensive care unit stay >6 days (3.55; 95% CI, 1.63-7.75). Utilizing regression coefficients, we created a risk index, named Neurological Complications Post-Liver Transplant score (NC-PoLT). A score ≥4 predicted neurological complications after liver transplant (area under the receiver operating curve of 0.87).

Conclusions: The NC-PoLT scoring index can serve as a tool to identify patients who may be at risk of developing neurological complications after living donor liver transplant. This internally validated metric aids in predicting outcomes and recognizing target groups for preventive strategies. However, an external validation of this score has not yet been conducted.