Early-Onset Seizures After Orthotopic Liver Transplantation: A Single-Center Retrospective Study.

Background: After encephalopathy, epileptic seizures (ES) are the second most common neurologic complication after orthotopic liver transplantation (OLT) and may announce a disabling/fatal neurologic disease.

Methods: In this retrospective study, we collected clinical information from patients who underwent OLT at our institution and analyzed outcomes and potential risk factors for developing ES after OLT.

Results: Fourteen of our 376 patients (3.72%) who underwent OLT had ES. After excluding 2 patients with already known epilepsy, among the other 12 patients, 2 were diagnosed with nonanoxic cerebral edema, 2 with anoxic damage, 1 with intracranial hemorrhage, 1 with metabolic derangement, and 4 with neurotoxicity; 2 did not receive a diagnosis of certainty. 9 of 12 patients had structural abnormalities on neuroimaging exams. Patients with ES had lower body mass index, higher rate of pretransplant portal thrombosis, and lower pre-transplant plasma concentration of albumin than patients without ES. Multiple post-transplantation systemic complications, postoperative infections, and graft rejection were correlated with a significantly higher risk of ES. Compared with patients without seizures, patients with ES had longer in-hospital and intensive care unit (ICU) length of stay, higher probability of ICU readmission, in-hospital death, and need for rehabilitation. Just 3 of the 12 patients with ES had a good prognosis, while the other 9 had at least mild neurologic sequelae, 5 of whom died because of the underlying neurologic disease.

Conclusions: ES after OLT may announce detrimental neurologic disease. When an underlying neurologic disease is excluded, prognosis in terms of seizure recurrence and long-term antiseizure medication need is warranted.