Korean J Transplant.  2023 Nov;37(Suppl 1):S69. 10.4285/ATW2023.F-6451.

Clinical impact and risk factors of seizure after liver transplantation: a nested case-control study

• Kim DG
• Yim SH
• Choi MC
• Min EK
• Lee JG
• Kim MS
• Joo DJ
• Lee C

• KMID: 2551656
• DOI: http://doi.org/10.4285/ATW2023.F-6451

Abstract

Background
Seizure is one of the most common neurological complications of liver transplantation (LT). However, the clinical impact and risk factors for seizures after LT have not been sufficiently investigated. This study evaluated the clinical impact and risk factors for seizures after LT.
Methods
The data of patients who underwent LT in a single tertiary hospital were analyzed using a nested case-control design. Patients diagnosed with seizures (seizure group) within 1-year posttransplantation were matched to controls who had not experienced seizures until the corresponding time points at a 1:5 ratio to perform survival and risk factor analyses.
Results
Seizures developed in 61 of 1,243 patients (4.9%); median time from LT to seizure was 11 (interquartile range, 6–26) days. Five-year graft loss was significantly lower in the seizure group than in the controls (50.6% vs. 78.2%, respectively; P<0.001) and seizure was a significant risk factor for graft loss after adjusting for variables (hazard ratio, 2.04; 95% confidence interval, 1.24–3.33). In multivariable logistic regression, body mass index <23 kg/m ² , donor age 45 years, intraoperative con-tinuous renal replacement therapy, delta sodium level 4 mmol/L, total bilirubin level 2.5 mg/dL, and albumin level <3.5 mg/dL emerged as independent risk factors for post-LT seizure. Delta sodium level 4 mmol/L was associated with seizures, regardless of the severity of preoperative hyponatremia.
Conclusions
This study showed the hazardous effects of seizures on LT outcomes and their risk factors. Identifying the risk factors and controlling perioperative changes in the sodium level are necessary to prevent post-LT seizures.