Longitudinal Evaluation of Delirium in Liver Transplant Recipients.

Background: Increasingly shorter intensive care unit stays have limited the screening for delirium and therefore our understanding of delirium risk and characteristics in the modern liver transplant population. Objective: We sought to evaluate delirium prevalence in the intensive care unit, on the surgical floor, and overall during the liver transplant hospitalization. Methods: We enrolled 50 liver transplant recipients to receive daily delirium assessments using both the 4AT and either the Confusion Assessment Method (CAM) for the ICU or the CAM short form immediately pre-transplant and until the first of discharge or post-transplant day 14. We evaluated delirium prevalence in the ICU, on the surgical floor, and overall and visualized the daily mental status of recipients and cumulative incidence of delirium in this cohort. Results: Delirium was present in 58% of recipients, including 47% in the ICU and 43% on the surgical floor. Nine participants (31%) were captured as having delirium only on the surgical floor. Demographic and transplant characteristics were statistically similar between recipients with and without post-transplant delirium. Compared to recipients without post-transplant delirium, recipients with delirium had similar ICU length of stay [3 (2-5) vs. 2 (1-3) days, p=0.24] but significantly longer transplant hospitalization length of stay [16 (13-20) vs. 8 (8-13), p=0.004]. Conclusions: Delirium is highly prevalent among liver transplant recipients not only during their stay in the intensive care unit, but also on the surgical floor. These findings underscore the importance of continuing routine assessment for delirium on liver transplant recipients after transfer to the surgical floor to optimize post-transplant care.