*Purpose: Delirium has been shown to impact the hospital courses of older adults. Liver transplant (LT) recipients are a population that has previously been identified as being at high risk for delirium, but characteristics of their delirium and its association with other hospitalization outcomes has not been explored.

*Methods: Delirium data based on CAM-ICU assessments recorded in the electronic health records (EHR) were collected for 262 LT recipients enrolled in a prospective cohort study at Johns Hopkins Hospital. Patients who were CAM-ICU-positive were classified as experiencing delirium; delirium subtype was classified by RASS score (hypoactive: RASS -3 to -1; hyperactive: RASS >+1). We used Fisher’s exact tests to compare delirium outcomes by patient characteristics.

*Results: Median (IQR) age of recipients at LT was 58 (52-64) years. Pre-transplant, 15.6% of recipients were admitted to the ICU, of whom 73.2% experienced delirium. Post-transplant, 100% of recipients were admitted to the ICU (per protocol), of whom 42.5% experienced delirium. Among patients who experienced delirium post-transplant (N=114), 56.1% had hypoactive delirium only, 7.0% had hyperactive delirium only, and 36.8% experienced both hypo- and hyperactive delirium. Benzodiazepines were given to 28.2% of LT recipients in the ICU, with a median (IQR) cumulative dose equivalent to 18.3 (10,40) mg valium. Likelihood of delirium was similar among patients who did and did not receive benzodiazepines (44.6% vs. 43.1%, p=0.8). 10.7% of LT recipients were still experiencing delirium on the day of transfer out of the ICU; likelihood of ICU readmission was similar among patients who were and were not delirious on day of ICU discharge (10.7% vs. 6.5%, p=0.4).

*Conclusions: Delirium is highly prevalent among liver transplant recipients both pre- and post-transplant. Delirium is often present at the time of discharge from the ICU, underscoring the need for ongoing delirium assessment of transplant recipients on the surgical floor. Further exploration of long-term effects of delirium in LT recipients is needed to understand whether its impact on long-term cognition is similar to findings in other populations of hospitalized older adults.

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