"This study found that alcoholics are much more confused than other patients following liver transplant," says E. F. M. Wijdicks, M.D., a Mayo Clinic neurologist and lead author of the study.
Typically, major neurologic complications occur in 10 percent to 20 percent of all liver transplant patients, usually showing up in the first month after surgery. As liver transplant due to alcoholic-liver disease has been on the rise in the United States, the study investigators wanted to determine whether alcohol had an impact on brain complications following transplant. Dr. Wijdicks cites alcoholic-liver disease as the second most common reason for liver transplant.
The study included 87 patients: 40 had alcoholic-liver disease and 47 had hepatitis C without a history of heavy alcohol use. Alcoholism was determined by the criteria set forth in The Diagnostic and Statistical Manual of "Normal" Disorders. All patients received liver transplants between 1990 and 2000, and their ages ranged from 50 to 70 years.
Of the 40 alcoholic-liver disease patients, 19 went into an acute confusional state within three to 31 days after transplant, while only three of 47 hepatitis C patients had this experience. The mental confusion involved interrupted sleep patterns and disorientation. Recovery and hospitalization also were prolonged in these patients due to acute confusion.
In this study, postoperative confusion includes disorientation (e.g., about oneself, one's whereabouts and location in time) or agitation for more than three days or that necessitates hospital admission.
Dr. Wijdicks believes that postoperative confusion and delirium in alcoholic-liver disease patients can be attributed to two major causes: 1) high levels of ammonia, a toxin that an unhealthy liver may no longer be able to convert to urea and excrete via the kidney and; 2) brain damage from alcohol.
Mayo Clinic liver transplantation protocol requires that all patients receiving liver transplant for alcoholic-liver disease must have abstained from all alcohol for a period of six months prior to surgery and participated in a rehabilitation program involving random urine and blood-alcohol tests. Although patients in this study had followed this protocol, the high-stress nature of liver transplant surgery triggered confusion due to past alcohol-induced brain damage, according to Dr. Wijdicks. The study also found length of sobriety proportional to the confusion and delirium patients experienced following transplant. Another finding: alcoholic-liver disease patients had more advanced liver disease than their counterparts with hepatitis C.
The study investigators indicate that this study points to the potential for using preventive antipsychotic drugs for alcoholic-liver disease patients undergoing treatment.
Lisa Copeland
507-538-0844 (days)
507-284-2511(evenings)
email:newsbureau@mayo.edu
Journal
Neurology