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21 May 2009

Peripheral neuropathy after liver transplantation

P Smoter, W Patkowski, K Zieniewicz, K Kobryń, O Kornasiewicz, I Grzelak, M Krawczyk

Ann Transplant 2009; 14(1): 44-44 :: ID: 880359

Abstract

Background: Every surgical procedure, even strictly following the rules, carries the risk of possible complications. After orthotropic liver transplantation (OLTx) high rate of various complications may be observed. Neuropathy is one of the rare possible complications of the procedure. The aim of the study was to evaluate the frequency rate of peripheral neuropathy after OLTx in the  material of The Department of General, Liver and Transplant Surgery.
Material/Methods: Clinical data of all orthotropic liver transplantations performed in The Department of General, Liver and Transplant Surgery in years 2000-2008 was analyzed and all cases of neuropathy were found. Early postoperative complications and their possible reasons as well as early results of treatment were assessed.
Results: In the group of 649 liver transplantations 10 cases (1.5%) of peripheral neuropathy were found. There were: 5 cases of peroneal nerve paralysis, 2 cases of upper limb paresis, 2 cases of upper limb paraesthesia and 1 case of facial nerve paralysis. There were 5 male and 5 female in the analyzed group. The age of patients varied from 22 to 59 years (mean age 39.3). Among underlying liver disease there were 3 cases of HCV hepatitis, 3 cases of cholestatic diseases, 2 cases of Wilson's disease, 1 case of HBV hepatitis and 1 case of hemangioendothelioma. All neuropathies were observed after elective operations in patients with no history of neurological complaints. The analysis of possible reasons of neuropathy indicated iatrogenic reason in 8 cases. The iatrogenic factor was related to cannulation of axillary vein (2 cases), nerve compression due to forced recumbent position (5 cases) and side effects of immunosuppression (2 cases). Non-iatrogenic reasons were viral infection (1 case) and shank injury (1 case). All patients were successfully treated with the use of rehabilitation and physiotherapyConclusions: Peripheral neuropathy, as a rare complication of OLTx, does not seem to be related to age, sex and the underlying reason for transplantation. Iatrogenic factors, mainly anaesthetic care, seem to be of greatest importance in the risk of neuropathy development. Improved standards of intraoperative care may contribute to diminishing the risk of that complication.

Keywords: Liver Transplantation, clinical outcome

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358