[The possible causes of serious central nervous system complications occurring after liver transplantation].

Objective: To study the classification, possible causes, cure and prevention measures of serious central nervous system (CNS) complications occurring early following liver transplantation.

Methods: The clinical material records of 347 patients undergoing the orthotopic liver transplantation from July 2001 to July 2006 were analyzed retrospectively. The perioperation risk factors of CNS complications, which might be the primary liver disease, serum sodium level, magnesium level, fluctuation degree of plasma osmolality and serum sodium, function of blood clotting, etc. , were analyzed between patients with serious CNS complications and without neurological complications.

Results: A total of 71 (20. 46%) neurological symptoms appeared in 347 postoperative patients who included 6 cases (1. 73%) with serious CNS complications such as cerebral edema, cerebral hemorrhage and central pontine myelinolysis, and of 6 cases, 5 patients died. The morbidity of early serious complications of CNS was higher in patients with decompensate cirrhosis and/or hypersplenism. Compared with the group of no neurological complications, two patients with cerebral hemorrhage suffered from preoperative hypersplenism and worse dysfunction of blood clotting (P<0. 05); patients with developed CPM and cerebral oedema had serious hyponatremia history before operation, and intensely fluctuated plasma osmolality showed before and after operation.

Conclusion: The onset of serious complications of CNS in recipients of liver transplantation may be intimately related to the primary liver disease, and be associated with chronic hyponatremia, rapid correction of serum sodium concentration, intense increase of plasma osmolality and no prompt rectification of the function of blood clotting during perioperation.