Risk Factors for Central Pontine and Extrapontine Myelinolysis following Orthotopic Liver Transplantation

Background: Central pontine myelinolysis (CPM)/extrapontine myelinolysis (EPM) is one of the most serious neurological complications that can occur after orthotopic liver transplantation (OLT). We analyzed the risk factors for CPM/EPM in OLT patients. Methods: We retrospectively reviewed the records of 1,247 patients who underwent OLT between 1992 and 2005. We compared demographic, clinical and biological parameters of patients with CPM/EPM with those of age-, sex- and operation date-matched patients without CPM/EPM (controls). Results: Of 1,247 patients, 11 (0.88%) were diagnosed with CPM/EPM based on neuroimaging findings. A higher Model for End-Stage Liver Disease-Na score, preoperative hyponatremia and as well as greater changes in electrolytes, especially sodium, during surgery, were observed in the CPM/EPM group (p < 0.05). Conclusion: CPM/EPM after OLT is more likely to occur in patients with more severe preoperative liver dysfunction and greater changes in electrolyte imbalance, especially sodium, during surgery. Copyright (C) 2009 S. Karger AG, Basel