Characterizing Delirium in Liver Transplant Recipients

Background Delirium is an increasingly recognized post-surgical complication but remains poorly understood among liver transplant (LT) recipients. Objective We sought to characterize the course, risk factors, and postoperative outcomes of post-LT delirium. Methods Among LT recipients enrolled in a prospective cohort study, we evaluated delirium using clinical care CAM-ICU assessments. We characterized delirium course using descriptive statistics and risk of delirium using multivariable logistic regression. Results Among 261 recipients, 42.5% experienced post-LT delirium. Risk factors included higher MELD, hepatic encephalopathy, alcohol-related liver disease, and pre-transplant ICU admission. On multivariable analysis, MELD at transplant (aOR 1.06 [95% CI 1.02-1.10], p=0.001) and pre-transplant ICU admission (aOR 2.35 [95% CI 1.02-5.38], p=0.04) remained associated with post-transplant delirium. Delirium began on post-transplant day 0-1, median (IQR) duration was 2 (1-3) days, and 30% screened positive on day of transfer out of the ICU. Delirium was associated with longer median ICU (2 vs. 1 days, p<0.001) and hospital (26 vs. 11 days, p<0.001) lengths of stay and higher likelihood of ICU readmission (12% vs. 4%,p=0.02), neurology consult (18% vs. 6%, p=0.002), and non-home discharge (33% vs. 7%, p<0.001). Conclusions The high prevalence of post-LT delirium and association with inferior post-transplant outcomes underscore the importance of recognizing post-LT delirium and implementing prevention strategies.