Research progress of evaluation, risk factors and intervening measures of delirium after liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Siqin ,  WU Menghang

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WU Menghang, Email: wumh1126@126.com

Keywords：

liver transplantation; postoperative delirium; risk factor; research progress

DOI：

10.7507/1007-9424.202207067

Video：

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Objective To investigate the evaluation, risk factors and intervening measures of postoperative delirium in patients after liver transplantation, and to provide reference for clinical practice. Methods The relevant literatures on delirium after liver transplantation at home and abroad in recent years were consulted. Based on the definition of postoperative delirium, the research status, evaluation tools and evaluation frequency at home and abroad were reviewed. From the aspects of donor and recipient, the influencing factors by connecting preoperative, intraoperative and postoperative stages and angles were explored. Results The incidence of postoperative delirium in patients with liver transplantation was high, and the risk factors were numerous, which ran through before and after liver transplantation. In terms of research type, most domestic and foreign studies were retrospective, single center, small sample surveys, with different assessment tools and assessment frequency. There were few high-quality intervention studies on delirium after liver transplantation. Conclusions Delirium after liver transplantation is predictable, evaluable and treatable. Effective risk assessment and screening are very important. Intervention for patients undergoing liver transplantation who develop postoperative delirium requires a combination of pharmacologic and non-pharmacologic interventions.

Citation： LI Siqin, WU Menghang. Research progress of evaluation, risk factors and intervening measures of delirium after liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 242-248. doi: 10.7507/1007-9424.202207067 Copy

1.	Meirelles Júnior RF, Salvalaggio P, Rezende MB, et al. Liver transplantation: history, outcomes and perspectives. Einstein (Sao Paulo), 2015, 13(1): 149-152.
2.	Berian JR, Zhou L, Russell MM, et al. Postoperative delirium as a target for surgical quality improvement. Ann Surg, 2018, 268(1): 93-99.
3.	Allen SR, Frankel HL. Postoperative complications: delirium. Surg Clin North Am, 2012, 92(2): 409-431.
4.	Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers, 2020, 6(1): 90. doi: 10.1038/s41572-020-00223-4.
5.	Butterworth RF. Hepatic encephalopathy in cirrhosis: pathology and pathophysiology. Drugs, 2019, 79(Suppl 1): 17-21.
6.	Jaffe A, Lim JK, Jakab SS. Pathophysiology of hepatic encephalopathy. Clin Liver Dis, 2020, 24(2): 175-188.
7.	Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Can J Anaesth, 2018, 65(11): 1248-1257.
8.	Sachdev PS, Blacker D, Blazer DG, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol, 2014, 10(11): 634-642.
9.	Chu NM, Segev DL, McAdams-DeMarco MA. Delirium among adults undergoing solid organ transplantation. Curr Transplant Rep, 2021, 8(2): 118-126.
10.	Zhou S, Deng F, Zhang J, et al. Incidence and risk factors for postoperative delirium after liver transplantation: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(8): 3246-3253.
11.	Zhou J, Xu X, Liang Y, et al. Risk factors of postoperative delirium after liver transplantation: a systematic review and meta-analysis. Minerva Anestesiol, 2021, 87(6): 684-694.
12.	程江丽, 董美玲, 张中伟, 等. 肝脏移植患者术后血糖变异性与ICU内谵妄的相关性研究. 四川大学学报(医学版), 2020, 51(3): 416-421.
13.	陈俊国, 王昊, 颉斌, 等. 肝移植术后谵妄的危险因素分析及预测指标评估. 器官移植, 2020, 11(4): 477-481.
14.	Chen J, Wang H, He Z, et al. Analysis of risk factors for postoperative delirium after liver transplantation. Neuropsychiatr Dis Treat, 2020, 16: 1645-1652.
15.	Wang SH, Wang JY, Lin PY, et al. Predisposing risk factors for delirium in living donor liver transplantation patients in intensive care units. PLoS One, 2014, 9(5): e96676. doi:10.1371/journal.pone.0096676.
16.	Lescot T, Karvellas CJ, Chaudhury P, et al. Postoperative delirium in the intensive care unit predicts worse outcomes in liver transplant recipients. Can J Gastroenterol, 2013, 27(4): 207-212.
17.	Patrono D, Rigo F, Bormida S, et al. Graft factors as determinants of postoperative delirium after liver transplantation. Updates Surg, 2020, 72(4): 1053-1063.
18.	Beckmann S, Schubert M, Burkhalter H, et al. Postoperative delirium after liver transplantation is associated with increased length of stay and lower survival in a prospective cohort. Prog Transplant, 2017, 27(1): 23-30.
19.	Bhattacharya B, Maung A, Barre K, et al. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation. J Surg Res, 2017, 207: 223-228.
20.	Yoon JS, Kim YR, Choi JW, et al. Risk factors of postoperative delirium following liver transplantation. Korean J Anesthesiol, 2009, 57(5): 584-589.
21.	Bush SH, Lawlor PG, Ryan K, et al. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol, 2018, 29(Suppl 4): iv143-iv165.
22.	Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): e825-e873. doi:10.1097/CCM. 0000000000003299.
23.	Wang J, Peng ZY, Zhou WH, et al. A national multicenter survey on management of pain, agitation, and delirium in intensive care units in China. Chin Med J (Engl), 2017, 130(10): 1182-1188.
24.	Soiza RL, Myint PK. The Scottish Intercollegiate Guidelines Network (SIGN) 157: guidelines on risk reduction and management of delirium. Medicina (Kaunas), 2019, 55(8): 491. doi: 10.3390/medicina55080491.
25.	Stollings JL, Kotfis K, Chanques G, et al. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med, 2021, 47(10): 1089-1103.
26.	Delirium, dementia, and depression in older adults: assessment and care, second edition. 2016. https://rnao.ca/bpg/guidelines/assessment-and-care-older- adults-delirium-dementia-and-depression.
27.	Lu RY, Zhu HK, Liu XY, et al. A non-linear relationship between preoperative total bilirubin level and postoperative delirium incidence after liver transplantation. J Pers Med, 2022, 12(2): 141. doi: 10.3390/jpm12020141.
28.	Lee H, Oh SY, Yu JH, et al. Risk factors of postoperative delirium in the intensive care unit after liver transplantation. World J Surg, 2018, 42(9): 2992-2999.
29.	Chaiwat O, Chanidnuan M, Pancharoen W, et al. Postoperative delirium in critically ill surgical patients: incidence, risk factors, and predictive scores. BMC Anesthesiol, 2019, 19(1): 39. doi:10.1186/s12871-019-0694-x.
30.	Ri HS, Choi YJ, Park JY, et al. Elevation of preoperative ammonia level is not associated with the incidence of postoperative delirium in patients with liver transplantation: a propensity score matching analysis. Transplant Proc, 2021, 52(1): 219-226.
31.	Raphael J, Hensley NB, Chow J, et al. Red blood cell transfusion and postoperative delirium in hip fracture surgery patients: a retrospective observational cohort study. Anesthesiol Res Pract, 2021, 8593257. doi:10.1155/2021/8593257.
32.	van der Zanden V, Beishuizen SJ, Swart LM, et al. The effect of treatment of anemia with blood transfusion on delirium: a systematic review. J Am Geriatr Soc, 2017, 65(4): 728-737.
33.	Chou MY, Wang YC, Peng LN, et al. Intraoperative blood transfusion predicts postoperative delirium among older patients undergoing elective orthopedic surgery: a prospective cohort study. Int J Geriatr Psychiatry, 2019, 34(6): 881-888.
34.	Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg, 2020, 130(6): 1572-1590.
35.	Zhou Q, Zhou X, Zhang Y, et al. Predictors of postoperative delirium in elderly patients following total hip and knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2021, 22(1): 945. doi: 10.1186/s12891-021-04825-1.
36.	Saager L, Duncan AE, Yared JP, et al. Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery. Anesthesiology, 2015, 122(6): 1214-1223.
37.	Lee J, Kim DK, Lee JW, et al. Rapid correction rate of hyponatremia as an independent risk factor for neurological complication following liver transplantation. Tohoku J Exp Med, 2013, 229(2): 97-105.
38.	Mihaylov P, Nagai S, Ekser B, et al. Prognostic impact of peritransplant serum sodium concentrations in liver transplantation. Ann Transplant, 2019, 24: 418-425.
39.	Tavabie OD, Colwill M, Adamson R, et al. A ‘real-world’ analysis of risk factors for post liver transplant delirium and the effect on length of stay. Eur J Gastroenterol Hepatol, 2019, 32(10): 1373-1380.
40.	Tien C, Remulla D, Kwon Y, et al. Contemporary strategies to assess and manage liver donor steatosis: a review. Curr Opin Organ Transplant, 2021, 26(5): 474-481.
41.	何彬, 高会霞, 李玉萍, 等. 肝移植患者术后谵妄的非药物干预. 护理学杂志, 2022, 37(3): 32-34.
42.	徐晓红, 宋燕波. 肝移植术后谵妄的评估和干预. 南京医科大学学报(自然科学版), 2009, 29(10): 1475-1476.
43.	潘丽, 贺学宇, 叶啟发. 肝移植术后谵妄的临床分析及干预. 武汉大学学报(医学版), 2017, 38(6): 933-935.
44.	Lee H, Yang SM, Chung J, et al. Effect of perioperative low-dose dexmedetomidine on postoperative delirium after living-donor liver transplantation: a randomized controlled trial. Transplant Proc, 2020, 52(1): 239-245.
45.	Pun BT, Balas MC, Barnes-Daly MA, et al. Caring for critically ill patients with the abcdef bundle: results of the ICU liberation collaborative in over 15 000 adults. Crit Care Med, 2019, 47(1): 3-14.
46.	Agar MR, Amgarth-Duff I. The dilemma of treating delirium: the conundrum of drug management. Curr Treat Options Oncol, 2022, 23(7): 951-960.
47.	Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev, 2021, 7(7): CD013307. doi:10.1002/14651858.CD013307.pub3.
48.	Santos E, Cardoso D, Neves H, et al. Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review. JBI Database System Rev Implement Rep, 2017, 15(5): 1440-1472.
49.	Burry L, Hutton B, Williamson DR, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev, 2019, 9(9): CD011749. doi:10.1002/14651858.CD011749.pub2.
50.	Burry LD, Cheng W, Williamson DR, et al. Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis. Intensive Care Med, 2021, 47(9): 943-960.

1. Meirelles Júnior RF, Salvalaggio P, Rezende MB, et al. Liver transplantation: history, outcomes and perspectives. Einstein (Sao Paulo), 2015, 13(1): 149-152.
2. Berian JR, Zhou L, Russell MM, et al. Postoperative delirium as a target for surgical quality improvement. Ann Surg, 2018, 268(1): 93-99.
3. Allen SR, Frankel HL. Postoperative complications: delirium. Surg Clin North Am, 2012, 92(2): 409-431.
4. Wilson JE, Mart MF, Cunningham C, et al. Delirium. Nat Rev Dis Primers, 2020, 6(1): 90. doi: 10.1038/s41572-020-00223-4.
5. Butterworth RF. Hepatic encephalopathy in cirrhosis: pathology and pathophysiology. Drugs, 2019, 79(Suppl 1): 17-21.
6. Jaffe A, Lim JK, Jakab SS. Pathophysiology of hepatic encephalopathy. Clin Liver Dis, 2020, 24(2): 175-188.
7. Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Can J Anaesth, 2018, 65(11): 1248-1257.
8. Sachdev PS, Blacker D, Blazer DG, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol, 2014, 10(11): 634-642.
9. Chu NM, Segev DL, McAdams-DeMarco MA. Delirium among adults undergoing solid organ transplantation. Curr Transplant Rep, 2021, 8(2): 118-126.
10. Zhou S, Deng F, Zhang J, et al. Incidence and risk factors for postoperative delirium after liver transplantation: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(8): 3246-3253.
11. Zhou J, Xu X, Liang Y, et al. Risk factors of postoperative delirium after liver transplantation: a systematic review and meta-analysis. Minerva Anestesiol, 2021, 87(6): 684-694.
12. 程江丽, 董美玲, 张中伟, 等. 肝脏移植患者术后血糖变异性与ICU内谵妄的相关性研究. 四川大学学报(医学版), 2020, 51(3): 416-421.
13. 陈俊国, 王昊, 颉斌, 等. 肝移植术后谵妄的危险因素分析及预测指标评估. 器官移植, 2020, 11(4): 477-481.
14. Chen J, Wang H, He Z, et al. Analysis of risk factors for postoperative delirium after liver transplantation. Neuropsychiatr Dis Treat, 2020, 16: 1645-1652.
15. Wang SH, Wang JY, Lin PY, et al. Predisposing risk factors for delirium in living donor liver transplantation patients in intensive care units. PLoS One, 2014, 9(5): e96676. doi:10.1371/journal.pone.0096676.
16. Lescot T, Karvellas CJ, Chaudhury P, et al. Postoperative delirium in the intensive care unit predicts worse outcomes in liver transplant recipients. Can J Gastroenterol, 2013, 27(4): 207-212.
17. Patrono D, Rigo F, Bormida S, et al. Graft factors as determinants of postoperative delirium after liver transplantation. Updates Surg, 2020, 72(4): 1053-1063.
18. Beckmann S, Schubert M, Burkhalter H, et al. Postoperative delirium after liver transplantation is associated with increased length of stay and lower survival in a prospective cohort. Prog Transplant, 2017, 27(1): 23-30.
19. Bhattacharya B, Maung A, Barre K, et al. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation. J Surg Res, 2017, 207: 223-228.
20. Yoon JS, Kim YR, Choi JW, et al. Risk factors of postoperative delirium following liver transplantation. Korean J Anesthesiol, 2009, 57(5): 584-589.
21. Bush SH, Lawlor PG, Ryan K, et al. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol, 2018, 29(Suppl 4): iv143-iv165.
22. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): e825-e873. doi:10.1097/CCM. 0000000000003299.
23. Wang J, Peng ZY, Zhou WH, et al. A national multicenter survey on management of pain, agitation, and delirium in intensive care units in China. Chin Med J (Engl), 2017, 130(10): 1182-1188.
24. Soiza RL, Myint PK. The Scottish Intercollegiate Guidelines Network (SIGN) 157: guidelines on risk reduction and management of delirium. Medicina (Kaunas), 2019, 55(8): 491. doi: 10.3390/medicina55080491.
25. Stollings JL, Kotfis K, Chanques G, et al. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med, 2021, 47(10): 1089-1103.
26. Delirium, dementia, and depression in older adults: assessment and care, second edition. 2016. https://rnao.ca/bpg/guidelines/assessment-and-care-older- adults-delirium-dementia-and-depression.
27. Lu RY, Zhu HK, Liu XY, et al. A non-linear relationship between preoperative total bilirubin level and postoperative delirium incidence after liver transplantation. J Pers Med, 2022, 12(2): 141. doi: 10.3390/jpm12020141.
28. Lee H, Oh SY, Yu JH, et al. Risk factors of postoperative delirium in the intensive care unit after liver transplantation. World J Surg, 2018, 42(9): 2992-2999.
29. Chaiwat O, Chanidnuan M, Pancharoen W, et al. Postoperative delirium in critically ill surgical patients: incidence, risk factors, and predictive scores. BMC Anesthesiol, 2019, 19(1): 39. doi:10.1186/s12871-019-0694-x.
30. Ri HS, Choi YJ, Park JY, et al. Elevation of preoperative ammonia level is not associated with the incidence of postoperative delirium in patients with liver transplantation: a propensity score matching analysis. Transplant Proc, 2021, 52(1): 219-226.
31. Raphael J, Hensley NB, Chow J, et al. Red blood cell transfusion and postoperative delirium in hip fracture surgery patients: a retrospective observational cohort study. Anesthesiol Res Pract, 2021, 8593257. doi:10.1155/2021/8593257.
32. van der Zanden V, Beishuizen SJ, Swart LM, et al. The effect of treatment of anemia with blood transfusion on delirium: a systematic review. J Am Geriatr Soc, 2017, 65(4): 728-737.
33. Chou MY, Wang YC, Peng LN, et al. Intraoperative blood transfusion predicts postoperative delirium among older patients undergoing elective orthopedic surgery: a prospective cohort study. Int J Geriatr Psychiatry, 2019, 34(6): 881-888.
34. Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg, 2020, 130(6): 1572-1590.
35. Zhou Q, Zhou X, Zhang Y, et al. Predictors of postoperative delirium in elderly patients following total hip and knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2021, 22(1): 945. doi: 10.1186/s12891-021-04825-1.
36. Saager L, Duncan AE, Yared JP, et al. Intraoperative tight glucose control using hyperinsulinemic normoglycemia increases delirium after cardiac surgery. Anesthesiology, 2015, 122(6): 1214-1223.
37. Lee J, Kim DK, Lee JW, et al. Rapid correction rate of hyponatremia as an independent risk factor for neurological complication following liver transplantation. Tohoku J Exp Med, 2013, 229(2): 97-105.
38. Mihaylov P, Nagai S, Ekser B, et al. Prognostic impact of peritransplant serum sodium concentrations in liver transplantation. Ann Transplant, 2019, 24: 418-425.
39. Tavabie OD, Colwill M, Adamson R, et al. A ‘real-world’ analysis of risk factors for post liver transplant delirium and the effect on length of stay. Eur J Gastroenterol Hepatol, 2019, 32(10): 1373-1380.
40. Tien C, Remulla D, Kwon Y, et al. Contemporary strategies to assess and manage liver donor steatosis: a review. Curr Opin Organ Transplant, 2021, 26(5): 474-481.
41. 何彬, 高会霞, 李玉萍, 等. 肝移植患者术后谵妄的非药物干预. 护理学杂志, 2022, 37(3): 32-34.
42. 徐晓红, 宋燕波. 肝移植术后谵妄的评估和干预. 南京医科大学学报(自然科学版), 2009, 29(10): 1475-1476.
43. 潘丽, 贺学宇, 叶啟发. 肝移植术后谵妄的临床分析及干预. 武汉大学学报(医学版), 2017, 38(6): 933-935.
44. Lee H, Yang SM, Chung J, et al. Effect of perioperative low-dose dexmedetomidine on postoperative delirium after living-donor liver transplantation: a randomized controlled trial. Transplant Proc, 2020, 52(1): 239-245.
45. Pun BT, Balas MC, Barnes-Daly MA, et al. Caring for critically ill patients with the abcdef bundle: results of the ICU liberation collaborative in over 15 000 adults. Crit Care Med, 2019, 47(1): 3-14.
46. Agar MR, Amgarth-Duff I. The dilemma of treating delirium: the conundrum of drug management. Curr Treat Options Oncol, 2022, 23(7): 951-960.
47. Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev, 2021, 7(7): CD013307. doi:10.1002/14651858.CD013307.pub3.
48. Santos E, Cardoso D, Neves H, et al. Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review. JBI Database System Rev Implement Rep, 2017, 15(5): 1440-1472.
49. Burry L, Hutton B, Williamson DR, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev, 2019, 9(9): CD011749. doi:10.1002/14651858.CD011749.pub2.
50. Burry LD, Cheng W, Williamson DR, et al. Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis. Intensive Care Med, 2021, 47(9): 943-960.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress of evaluation, risk factors and intervening measures of delirium after liver transplantation

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