Abstracts

This study obtained observational data on a cohort of Liver transplant recipients (LTR) who developed seizures post-operatively with the purpose of proposing a risk factor profile and develop a preventive treatment strategy. A retrospective review of the University of Minnesota Transplant Registry from 1998-2003 identified that out of 315 adult LTR, 31 had de novo seizures during the post-operative period or subsequently. In this cohort, 94 parameters were analyzed in the following categories: demographics, etiology, characteristic of seizures, CT/MRI, EEG, metabolic parameters, morbidity, mortality, pre-morbid risk factors and treatment applied. Mean follow-up after transplant was 22 months ( range, 1-62). Neurological complications occurred in 86 (27%) of the LTR with seizures in 31 (10%).
The following surgical procedures, all from deceased donors, were performed: orthotopic liver transplants in 24, split liver transplant in 5, and liver and kidney transplants in 2. Indications for transplant were: alcoholic liver disease in 12, hepatitis B,C in 16, and others in 3. Mean age of cohort was 52 yrs (range 33-66) and an increase number of African-Americans and Asians ( 14%) was noted.
Seizures occurred in 17 LTR at a mean of 12 days post-op (range 5-29), and in 14 at different post-op time up to 3 years. Myoclonic seizures and GTC occurred in10, 6 had partial seizures and in12 seizures could not be classified. 3 had status epilepticus.
Drug treatment with IV/po loading was: DPH in 13, VPA in 4, LVTM in 1 and 12 were untreated because seizures were single or mild.
Etiology of seizures was: metabolic/neurotoxic in 13, vascular events in 3, infection in 3, anoxia in 1 and unknown in 11.
MRI/CTscans showed: Normal in 7 (26%), PRES (all forms) in 13 (48%), abnormal basal ganglia in 5 (19%) due to ? hypermanganesemia, generalized atrophy in 4 (15%) and thalamic abcess in 1
EEG was abnormal in 20 out of 24 recorded, with seizure activty in 11.Slowing of the background was seen in 20 subjects and intermittent slowing in 10. PLEDS was seen in 1 subject and a seizure was recorded in 2.
At the end of 3 years 14 (45%) of the patients had died; 5 during initial hospitlization, 4 in subsequent hospitalizations, and 5 in follow-up. None of the death occurred as a result of seizures. Seizures ocurred in 10% of LTR. They ocurred during first 2 weeks in 55%, but in the others at subsequent follow-up time.
In 12 (39%) seizures were mild, infrequent and were not treated.
Etiology of seizures was mostly metabolic/neurotoxic.
MRI changes were commonly seen and they were more diagnostic than EEG. PRES changes were seen in 13 (42%), with 6 of unknown cause raising the question of other etiologies.
There were no pre-morbid predictive factors for development of seizures in LTR.