To investigate the causes, prevention and treatment of seizures following liver transplantation (LT).

In the 772 patients undergoing LT in Organ Transplantation Center, the third Affiliated Hospital of Sun Yat-sen University from October 2003 to June 2009, clinical data of 8 patients who developed seizures during the follow-up after operation were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 5 males and 3 females with age ranging from 46 to 58 years old and median age of 54 years old. The patients received regular reexaminations of blood routine, liver function, renal function, electrolytes, blood concentration of immunosuppressant, infection related etiological examinations, etc. The examinations of electroencephalogram (EEG), computed tomography (CT), or magnetic resonance imaging (MRI) were completed for the suspicious patients of seizures. The causes of disease, diagnosis, treatments and outcome of the patients were analyzed, including the incidence, onset time, seizures types, etiological analysis, treatments and outcome.

The incidence of seizures following LT was 1.0% (8/772), in which 1 case occurred in 1 week after operation, 2 cases within 5 to 6 weeks, 5 cases over 16 weeks and the longest case over 7 years after operation. Generalized tonic-clonic seizure was observed in 7 cases, including 2 cases developed to status epilepticus and 1 case of complex partial seizure. The etiological analysis revealed that 1 case had a history of seizures and 2 cases had hepatic encephalopathy before operation. Water-electrolyte imbalance occurred in 6 cases after operation including 2 cases complicated with hypoglycemia. And cerebral apoplexy occurred in 4 cases after operation including 1 case complicated with abnormally elevating blood concentration of tacrolimus (FK506), 1 case complicated with intracranial fungus and cytomegalovirus infections. Sedative and antiepileptic were given to all of 8 patients and various inducements were treated. Two cases recovered well and were discharged from hospital, and 6 cases died of multiple organ dysfunction syndrome or cerebral hemorrhage.

Seizures following LT may be related with many factors such as preoperative history of seizures and hepatic encephalopathy, immunosuppressant toxicity, water-electrolyte imbalance, cerebral apoplexy and intracranial infections after operation, etc. Once seizures are confirmed, sedative and antiepileptic should be given to the patients and various inducements should be treated. The prognosis of the patients is poor.