Wernicke's Encephalopathy in Alcohol Use Disorder Patients after Liver Transplantation: A Case Series and Review of Literature

Gabriele A Vassallo; Antonio Mirijello; Tommaso Dionisi; Claudia Tarli; Giuseppe Augello; Antonio Gasbarrini; Giovanni Addolorato; On Behalf Of The Gemelli Olt Group

doi:10.3390/jcm9123809

Wernicke's Encephalopathy in Alcohol Use Disorder Patients after Liver Transplantation: A Case Series and Review of Literature

J Clin Med. 2020 Nov 25;9(12):3809. doi: 10.3390/jcm9123809.

Authors

Gabriele A Vassallo¹, Antonio Mirijello², Tommaso Dionisi³, Claudia Tarli³, Giuseppe Augello¹, Antonio Gasbarrini^{4

5}, Giovanni Addolorato^{3

6}, On Behalf Of The Gemelli Olt Group

Affiliations

¹ Department of Internal Medicine, Barone Lombardo Hospital, 92024 Canicattì, Italy.
² Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, 71013 San Giovanni Rotondo, Italy.
³ Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
⁴ Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
⁵ Institute of Internal Medicine and Gastroenterology, Catholic University of Rome, 00168 Rome, Italy.
⁶ Internal Medicine Unit, Columbus-Gemelli Hospital, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.

Abstract

Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency, commonly found in alcohol use disorder (AUD) patients. Liver transplantation (LT) could represent a risk factor for the onset of WE in AUD patients, due to the onset of chronic depletion of thiamine in this population and the high metabolic demand of surgery and the postoperative period. However, few data are available about the risk of the onset of WE in AUD patients after LT. Here we report three cases of AUD patients who developed WE with confusion and delirium after LT. Prompt parenteral administration of thiamine led to a rapid improvement of the clinical condition and a complete remission of neurological symptoms after 3-4 days. In addition, a search of the available English literature was conducted in order to perform a review of the possible association between the onset of WE and LT in AUD patients. A prophylactic treatment regimen based on the administration of thiamine could be suggested in AUD patients before and after LT. Further studies are needed to determine the optimal regimen of thiamine in the prevention of WE in this setting.

Keywords: Korsakoff syndrome; Wernicke’s encephalopathy; alcohol use disorders; alcohol-related cirrhosis; alcohol-related liver disease; liver transplantation.