Objective  To systematically review the influencing factors of postoperative delirium (POD) in liver transplant recipients, providing a basis for future clinical intervention studies.

Methods  Literature were searched on the influencing factors of POD in liver transplant recipients published in the China Biology Medicine disc (CBM), Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP Information, PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases from their inception to February 28, 2025. The influencing factors of POD were extracted and analyzed in liver transplant recipients.

Results  A total of 12 articles were included. The influencing factors of POD in liver transplant recipients included patient factors (body mass index, history of preoperative alcohol abuse, history of infection within 2 months before surgery, preoperative hepatic encephalopathy, proportion of preoperative macrovesicular steatosis, preoperative model for end-stage liver disease score, acute physiology and chronic health evaluation II score, preoperative blood ammonia, preoperative total bilirubin, preoperative serum creatinine), surgical factors (long anhepatic period during surgery), treatment factors (perioperative medication use, prolonged intubation time, use of donation after cardiac death grafts), and postoperative related factors (elevated postoperative aspartate aminotransferase, postoperative sepsis, use of postoperative immunosuppressive drugs).

Conclusions  POD in liver transplant recipients is influenced by multiple factors. A multidimensional assessment and preventive strategy are required. Future research need focus on dynamic monitoring of delirium and personalized intervention plans.