Early neurological complications after pediatric liver transplantation: Imaging findings

Neurological complications are associated with increased morbidity and mortality after liver transplant (LT). Here, we investigated the frequency of neurological complications after neurological diagnosis and neuroimaging findings in pediatric patients who underwent brain MRI at specific intervals because of neurological symptoms after LT. We retrospectively analyzed 182 patients (aged <18 years) who underwent LT between 2012 and 2024 at our university hospital in Turkey. We collected demographic information, neurological symptoms and diagnosis, neuroimaging findings, abnormal blood test results, early postoperative complications, pediatric end-stage liver disease (PELD, for patients aged <12 y) and MELD (for patients aged >12 y) scores, and mortality. Central nervous system complications were classified based on time post-LT as acute or early (occurring <1 month posttransplant) and subacute or chronic (occurring 1 month-3 years posttransplant). Of 182 patients, 26 (14.3%) had early neurological complications. The 2 most common symptoms and indications for neuroimaging were seizure (50%) and altered mental status (34.6%). The most common complications were posterior reversible encephalopathy syndrome (46.2%), intracranial hemorrhage (15.4%), and hypoxic ischemic encephalopathy (11.5%). Eleven patients had vasogenic edema. Among patients with early neurological complications, those with cytotoxic edema had significantly higher abnormal laboratory parameters ( P < .05). Patients with cytotoxic edema showed a higher frequency of abnormal laboratory findings. However, when individual laboratory parameters were analyzed as continuous variables, no statistically significant differences were observed between MRI pattern groups (p > 0.05), despite relatively higher median values in the cytotoxic edema group. However, no differences were shown in neurological complication rates between patients who developed early postoperative complications and those who did not. PELD and MELD scores of those with early versus subacute neurological complications were not significantly different. No significant association was shown between neurological complications and mortality. With early postoperative neurological complications being an important cause of morbidity in pediatric LT recipients, timely use of MRI can expedite diagnosis and treatment and can help prevent potential adverse outcomes.