The Diagnosis And The Treatment Of The Seizures After Liver Transplantation

Objective To analyze the orthotopic liver transplantation (OLT) patients with new-onset seizures in the First Affiliated Hospital of Zhejiang University, and minimize the risks for those patients undergoing this procedure, including both cadaveric and living donor liver transplantation.Methods We retrospectively analyzed the incidence, aetiology, diagnosis, treatment and prognosis of these patients with new-onset seizures after OLT among 342 consecutive recipients in the past four years.Results Seizures occurred in 8 patients among the 342 OLT patients. The seizures of 6 patients occurred within two weeks following the liver transplantation. Generalized tonic-clonic seizures (GTC) were the most common seizure type(n=7, 87.5%) in the 8 patients, with focal seizure of 1 patient. And suspected etiologys of seizures was identified in most patients, including immunosuppressant toxicity (n=2, 25%), central nervous system (CNS) fungal infection (n=2,25%), neurotoxicity of immunosuppressive therapy and the high serum ammonia level (n=1,12.5%), vascular malformation (n=1,12.5%), electrolyte disturbances (n=1,12.5%), and cerebral infarction (n=1,12.5%). At last, after undergoing the treatment of the underlying cause of the seizures together with the antiepileptic medication, all 8 patients recovered with no severe aftereffect.Conclusion Seizures are still common after OLT. Early prevention, rapid and accurate diagnosis, appropriate and in-time treatment is very important. Each liver transplantation team should pay more attention to the high risk factors of seizures after the OLT, and correct them before the occurance of seizures. And appropriate treatments should be achieved considering the complicated medical condition of patients, especially the interaction among the multimodal therapy.