Semin Neurol 2024; 44(06): 670-694
DOI: 10.1055/s-0044-1789004
Review Article

Altered Mental Status in the Solid-Organ Transplant Recipient

Nicolas Weiss*
1   Sorbonne Université, AP-HP.Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Neurological ICU, Paris, France
,
Henning Pflugrad*
2   Department of Neurology, Agaplesion Ev. Klinikum Schaumburg, Obernkirchen, Germany
,
Prem Kandiah
3   Department of Neurology, Emory University Hospital, Atlanta, Georgia
› Author Affiliations
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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.

* N.W. and H.P. are co–first authors. Both authors contributed equally to the manuscript.




Publication History

Article published online:
24 August 2024

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