The aim of the study was to disclose a possible association of hearing defects with the use of either cyclosporin (CyA) or tacrolimus in patients undergoing liver transplantation (LT). Pure-tone audiometry (PTA) was performed in the same 42 patients before and after LT. Audiometric frequencies recorded ranged from 250 to 8000 Hz. Patients were divided into 2 groups according to the use of CyA (n ϭ 18) or FK-506 (n ϭ 24). We used Kolmogorov-Smirnov and subsequently Student t test, nonparametric Wilcoxon signed-rank test, and Mann-Whitney test for statistical analysis. Significance was achieved when P Յ 0.05. There was a statistically significant change in PTA results, occurring as decreased hearing perception, especially in high frequencies (4000, 6000, and 8000 Hz), in both ears of patients undergoing LT and receiving FK-506. Audiometric changes were not perceived pre-and posttransplantation in patients using CyA, except in the right ear, in the 3000-Hz range. In conclusion, LT patients presented worsening of hearing patterns after undergoing transplantation. The defect was significantly more accentuated in the high-frequency tones, particularly in individuals using FK-506 as the immunosuppressive regimen. Liver Transpl 14: [509][510][511] 2008 Cyclosporin (CyA) and tacrolimus (FK-506) are macrolide immunosuppressive agents frequently used in human transplantation. Erythromycin, clarithromycin, and azithromycin are also macrolide antibiotics known to produce detectable, dose-and time-dependent hearing loss, sometimes irreversible. 1-3 Pure-tone audiometry (PTA) is the most commonly used methodology to evaluate quantitatively the perception of hearing loss, measuring sound frequencies varying from 250 Hz to 8000 Hz. Ototoxicity occurs when auditory loss is greater than 25 dB in any of the mentioned frequencies. The most frequent initial manifestation of drug ototoxicity occurs in the higher tones (acute sounds), progressing thereafter through the median and low range frequencies. 4 The aim of this work was to compare possible hearing changes, detected by PTA, and measured in the same patients before and after liver transplantation (LT), induced either by CyA or FK-506. PATIENTS AND METHODSA total of 107 patients on the LT waiting list at the Irmandade da Santa Casa de Misericó rdia Hospital LT Group were submitted to pretransplant PTA. However, only 42 of 107 underwent LT surgery from 2000 to 2003. These 42 patients were submitted to PTA in the pretransplantation period and after the surgery. Mean age was 47.3 years (range, 16-70 years), 23 were male, with no past history of previous hearing changes. Patients with hearing loss secondary to acoustic trauma or drug ototoxicity were not considered for analysis. Patients were divided into 2 groups according to the immunosuppressive regimen adopted: 18 were treated with CyA, mean age was 46.2 years (7 under 49 years and 11 more than 50 years); 12 were male. In the FK-506 group (hereafter simply the FK group) (n ϭ 24) mean age was 48.1 year (13 under 49 years and 11 m...

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