Pediatric Transplantaton 2017; e12872; wileyonlinelibrary.com/journal/petr | 1 of 6 DOI: 10.1111/petr.12872 © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted: 16 November 2016 DOI: 10.1111/petr.12872 ORIGINAL ARTICLE Early and late neurological complicatons of liver transplantaton in pediatric patents Serdal Gungor 1 | Betul Kilic 1 | Mujgan Arslan 1 | M. Ayse Selimoglu 2 | Hamza Karabiber 2 | Sezai Yilmaz 3 1 Department of Pediatric Neurology, Faculty of Medicine, İnönü University, Malatya, Turkey 2 Department of Pediatric Gastroenterology, Hepatology and Nutriton, Faculty of Medicine, İnönü University, Malatya, Turkey 3 Department of Surgery, Faculty of Medicine, İnönü University, Malatya, Turkey Correspondence Betul Kilic, MD, Department of Pediatric Neurology, İnönü University Medical Faculty, Malatya, Turkey. Email: betulklc82@gmail.com Abstract NCs occur commonly afer solid organ transplantaton and afect 15%-30% of liver transplant recipients. The aim of this retrospectve study was to evaluate the type and incidence of neurologic events in pediatric patents following LT. Between May 2006 and June 2015, 242 patents (118 females, 124 males) requiring LT for diferent etolo- gies at the İnönü University Liver Transplantaton Insttute were included. The inci- dence, types, and risk factors of NCs that occurred following LT were evaluated retrospectvely. Neurologic events occurred in 57 (23.5%) of the patents. Early NCs were encephalopathy (12.4%), seizures (11.5%), and PRES (7%). Of 57 patents, fve (8.7%) experienced NCs at least 1 month afer LT; these late NCs included tremor, headaches, encephalopathy, ataxia, and neuropathy. The psychiatric symptoms afer LT were noted in 42 patents (17.4%). The mortality rate afer LT in those with or with- out neurological events was not signifcantly diferent (P=.73). There was a high inci- dence of serious neurologic events afer LT. The major neurologic manifestaton in our patents was encephalopathy followed by seizures. KEYWORDS childhood, liver transplantaton, neurological complicaton 1 | INTRODUCTION LT is the only successful treatment modality for pediatric patents with end-stage liver disease or acute liver failure. Advances in surgical techniques, postoperatve management, and the appropriate use of immunosuppressant agents have enhanced patent and graf survival following pediatric LT. 1,2 NCs that can occur following LT in children are reported being more severe and are associated with greater mortality compared with adults. 3,4 Various factors play a role in the pathogenesis of NCs following LT including poorly functoning graf, electrolyte and metabolic de- rangements, intracranial hemorrhage, cerebral infarcton, infecton, or immunosuppressant toxicity. 5 Seizures are the most common NCs afer LT. 3,6 Various other NCs reported afer LT are encephalopathy, PRES, stroke, meningits, central pontne myelinolysis, cerebellar syn- dromes, headache, neuropsychiatric manifestatons, cognitve decline, sleep disturbances, tremors, and peripheral neuropathy. 3-10 Routne preoperatve neurological evaluaton and close follow-up afer LT are needed for detectng the earliest signs of complicatons and initatng prompt and appropriate treatment or interventon. 3,4 We retrospectvely reviewed 242 consecutve pediatric LT cases to assess the incidence, types, and risk factors of NCs that occurred following LT. 2 | METHODS The medical records of 242 children (age <18 years) who underwent LT between May 2006 and June 2015 at Inönü University Liver Abbreviatons: CNS, central nervous system; CT, computerized tomography; DDLT, de- ceased donaton liver transplantaton; EEG, electroencephalography; EMG, electroneuromy- ography; FLAIR, fuid-atenuated inversion recovery; GABA, gamma aminobutyric acid; IHS, Internatonal Headache Society; LDLT, living-donor liver transplantaton; LT, liver transplan- taton; MRI, magnetc resonance imaging; NCs, neurologic complicatons; NMDA, N-methyl d-aspartate; PRES, posterior reversible leukoencephalopathy syndrome.