Article ; Online: Donor Age Predicts Calcineurin Inhibitor Induced Neurotoxicity After Liver Transplantation.
2019 Volume 103, Issue 8, Page(s) e211–e215
Abstract: Background: Calcineurin inhibitor-induced neurotoxicity (CIIN) is a common and debilitating side effect after liver transplantation (LT). Risk factors and impact on patient outcomes are not well defined. Our aim was to assess the incidence, risk factors, ...
| Abstract | Background: Calcineurin inhibitor-induced neurotoxicity (CIIN) is a common and debilitating side effect after liver transplantation (LT). Risk factors and impact on patient outcomes are not well defined. Our aim was to assess the incidence, risk factors, and clinical outcomes of CIIN. Methods: We retrospectively analyzed 175 LTs performed at our center between January 2010 and September 2016. Donor and recipient demographics as well as clinical variables pre-LT, intra-LT, and post-LT were assessed. All patients were on once-daily prolonged-release tacrolimus. Results: CIIN was described in 37 (21.4%) recipients. In univariate analysis, history of hepatic encephalopathy (P = 0.033), immunosuppressant treatment protocol (P = 0.041), donor age (P = 0.002), and pre-LT sodium serum levels (P = 0.004) were associated with CIIN. Patients undergoing LT for hepatocellular carcinoma had lower rates of CIIN (P = 0.040). In multivariate analysis, hepatic encephalopathy (odds ratio [OR], 2.728; 95% confidence interval [CI], 1.098-6.779; P = 0.031), pre-LT serum sodium levels (OR, 1.118 per mEq/L increase, 95% CI, 1.021-1.224; P = 0.016), and donor age (OR, 1.032 per y increase; 95% CI, 1.004-1.062; P = 0.027) were independent risk factors for developing CIIN. In the CIIN group, patients had longer intensive care unit (P = 0.024) and hospital (P = 0.008) stays and more changes in immunosuppressive treatment (54.1% vs 20.4%; P < 0.001). Conclusions: Neurotoxicity remains frequent in patients on once-daily prolonged-release tacrolimus. Antecedents of hepatic encephalopathy, pre-LT sodium serum levels, and donor age are independent risk factors for developing CIIN after LT. CIIN is associated with longer hospital stays and changes in immunosuppressive treatment. |
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| MeSH term(s) | Aged ; Calcineurin Inhibitors/adverse effects ; Delayed-Action Preparations ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Graft Rejection/prevention & control ; Humans ; Incidence ; Liver Transplantation ; Male ; Middle Aged ; Neurotoxicity Syndromes/epidemiology ; Neurotoxicity Syndromes/etiology ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Spain/epidemiology ; Tacrolimus/adverse effects ; Tacrolimus/therapeutic use ; Tissue Donors |
| Chemical Substances | Calcineurin Inhibitors ; Delayed-Action Preparations ; Tacrolimus (WM0HAQ4WNM) |
| Language | English |
| Publishing date | 2019-04-11 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 208424-7 |
| ISSN | 1534-6080 ; 0041-1337 |
| ISSN (online) | 1534-6080 |
| ISSN | 0041-1337 |
| DOI | 10.1097/TP.0000000000002750 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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