Abstract
Patients undergoing solid-organ transplantation (SOT) face a tumultuous journey. Prior
to transplant, their medical course is characterized by organ dysfunction, diminished
quality of life, and reliance on organ support, all of which are endured in hopes
of reaching the haven of organ transplantation. Peritransplant altered mental status
may indicate neurologic insults acquired during transplant and may have long-lasting
consequences. Even years after transplant, these patients are at heightened risk for
neurologic dysfunction from a myriad of metabolic, toxic, and infectious causes. This
review provides a comprehensive examination of causes, diagnostic approaches, neuroimaging
findings, and management strategies for altered mental status in SOT recipients. Given
their complexity and the numerous etiologies for neurologic dysfunction, liver transplant
patients are a chief focus in this review; however, we also review lesser-known contributors
to neurological injury across various transplant types. From hepatic encephalopathy
to cerebral edema, seizures, and infections, this review highlights the importance
of recognizing and managing pre- and posttransplant neurological complications to
optimize patient outcomes.
Keywords
altered mental status - solid-organ transplant - hepatic encephalopathy - hyperammonemia
- white matter lesions - acute liver failure - calcineurin inhibitor toxicity - cognitive
dysfunction - donor-derived infection - air embolism
