24th Congress of the Spanish Liver Transplantation SocietyComplicationDifferences in the Incidence and Clinical Evolution of Early Neurotoxicity After Liver Transplantation Based on Tacrolimus Formulation Used in the Immunosuppressive Induction Protocol
Section snippets
Patients and Methods
We designed a matched, case-control study recording baseline characteristics, pretransplant liver and kidney function parameters, operative technical characteristics, kidney function after OLT, and tacrolimus levels during the first month after OLT. Seventy-one consecutive liver patients recipients (cases group) treated from February 2011 to December 2012 with an immunosuppressive induction regimen using basiliximab (20 mg in days 1 and 4 posttransplantation), a standard tapering steroids
Results
We analyzed 142 patients (120 men and 22 women) who underwent liver transplantation at a mean age of 56.2 ± 8.3 years, with a Model for End-stage Liver Disease score of 13.1 ± 5.4. Alcoholic cirrhosis was present in 86 cases (61%) and viral cirrhosis in 30 (21%). Fifty-six patients (38%) had a past history of encephalopathy, with 34 presenting (23%) with clinical signs at transplantation. There were no differences in the baseline, technical characteristics, or donor age between cases and
Discussion
CNI-induced neurotoxicity is among the more debilitating adverse events after OLT, with a prevalence rate of 6% to 47% of recipients treated with CNI-based immunosuppression [7]. Clinical manifestation range from mild tremor to an early, severe syndrome defined by confusion, agitation, altered level of consciousness, seizure, psychosis, focal symptoms, coma, or leukoencephalopathy, and in absence of other neurologic lesion (ie, ECIIN) [8]. ECIIN is considered as the most frequent adverse event
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Cited by (11)
Tacrolimus Concentrations Measured in Excreted Bile in Liver Transplant Recipients: The STABILE Study
2018, Clinical TherapeuticsCitation Excerpt :However, this surrogate marker imperfectly reflects TAC immunosuppressive activity or toxicity. Indeed, in patients undergoing LT, TACblood was not able to predict the occurrence of acute cellular rejection2 or TAC-related adverse effects,3,4 especially during the early postoperative days (PODs) because the liver graft is progressively recovering its metabolic function.5 This is particularly true considering TAC neurotoxic effects, which occur in approximately 20%4 of the patients after LT. In fact, this can be neither predicted nor treated except by temporary TAC suspension and subsequent spontaneous regression.
Clinical Challenges of Tacrolimus for Maintenance Immunosuppression Post–Lung Transplantation
2017, Transplantation ProceedingsCitation Excerpt :It is not expected to completely resolve all tacrolimus-related neurotoxicity, but symptoms related to high Cmax have improved with this approach. Neurotoxicity is more common with tacrolimus than cyclosporine, and substituting one CNI for another has been successfully reported [42]. In serious manifestations of tacrolimus-induced neurotoxicity, discontinuing the tacrolimus and initiating an mTOR inhibitor may be necessary.
Neurologic outcome following liver transplantation for methylmalonic aciduria
2023, Journal of Inherited Metabolic DiseaseNeurotoxicity after liver transplantation: Does donor age matter?
2021, Translational Gastroenterology and HepatologyTacrolimus-Induced Optic Neuropathy After Multivisceral Transplantation
2020, Transplantation Direct