Differences in the Incidence and Clinical Evolution of Early Neurotoxicity After Liver Transplantation Based on Tacrolimus Formulation Used in the Immunosuppressive Induction Protocol

Souto-Rodríguez, Raquel; Pérez, E. Molina; Castroagudı́n, J.F.; Pérez, A.; Otero-Antón, Esteban; Rituerto, S. Tomé Martínez de; Martínez-Castro, J.; Varo-Pérez, Evaristo

doi:10.1016/j.transproceed.2014.10.006

Cited by 10 publications

(6 citation statements)

References 9 publications

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“…This association may reflect neurotoxicity associated chronic malnutrition, which may worsen under Tac-based regimens, resulting in early change to a CsA-based ISx. 26 …”

Section: Discussionmentioning

confidence: 99%

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Nazzal

Lentine

Naik

et al. 2018

Transplantation Direct

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“…This association may reflect neurotoxicity associated chronic malnutrition, which may worsen under Tac-based regimens, resulting in early change to a CsA-based ISx. 26 …”

Section: Discussionmentioning

confidence: 99%

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Nazzal

Lentine

Naik

et al. 2018

Transplantation Direct

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“…Previous studies in non‐MMA transplanted patients reported an incidence of CNI‐induced neurotoxicity in 20% of the transplanted adults and 8% of pediatric patients . The incidence of CNI‐induced PRES has been reported to range from 0.34% to 1% of the non‐MMA patients after transplantation .…”

Section: Discussionmentioning

confidence: 99%

Neurotoxicity including posterior reversible encephalopathy syndrome after initiation of calcineurin inhibitors in transplanted methylmalonic acidemia patients: Two case reports and review of the literature

Molema¹,

Williams²,

Langendonk

et al. 2020

JIMD Reports

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Introduction New neurological symptoms in methylmalonic acidemia (MMA) patients after liver and/or kidney transplantation (LKT) are often described as metabolic stroke‐like‐events. Since calcineurin inhibitors (CNIs) are a well‐known cause of new neurological symptoms in non‐MMA transplanted patients, we investigated the incidence of CNI‐induced neurotoxicity including posterior reversible encephalopathy syndrome (PRES) in post‐transplanted MMA patients. Methods We report the two MMA patients treated with LKT in our center. Additionally, we performed a systematic review of case reports/series of post‐transplanted MMA patients and determined if CNI‐induced neurotoxicity/PRES was a likely cause of new neurological symptoms. Definite CNI‐induced neurotoxicity was defined as new neurological symptoms during CNI treatment with symptom improvement after CNI dose reduction/discontinuation. PRES was defined as CNI‐induced neurotoxicity with signs of vasogenic edema on brain magnetic resonance imaging (MRI)‐scan post‐transplantation. Results Our two MMA patients both developed CNI‐induced neurotoxicity, one had PRES. In literature, 230 transplanted MMA patients were identified. Neurological follow‐up was reported in 54 of them, of which 24 were excluded from analysis since no anti‐rejection medication was reported. Thirty patients, all using CNI, were included. Sixteen patients (53%) had no new neurological symptoms post‐transplantation and five patients (17%) had definite CNI neurotoxicity of whom two had PRES. Including our cases this results in a pooled incidence of 22% (7/32) definite CNI neurotoxicity and 9% PRES (3/32) in post‐transplanted MMA patients on CNI. Conclusion In MMA post‐transplanted patients with new neurological symptoms CNI‐induced neurotoxicity/PRES should be considered. Early recognition of CNI‐induced neurotoxicity is essential to initiate dose reduction/discontinuation of CNI to minimize persistent neurologic damage and improve outcome. Concise one sentence take home message In all post‐transplanted MMA patients with new neurological symptoms CNI‐induced neurotoxicity/PRES should be considered, and directly reducing the dose/discontinuation of CNI is essential.

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“…Sudden onset of acute movement disorders and persistent tremors are known complications in transplanted immunosuppressed individuals treated with CNI drugs, with an incidence of 20% in adults and 8% in pediatric patients. 59,60 In a recent literature review on post-TX neurological follow-up in methylmalonic aciduria, the incidence of CNI-induced neurotoxicity was reported to be comparable to non-methylmalonic aciduria transplanted patients. 29 Even if limited to a small number of cases, our experience shows that the incidence of this complication could be higher, approaching 50% of patients, highlighting that methylmalonic aciduria is particularly vulnerable to CNI-induced neurotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Neurologic outcome following liver transplantation for methylmalonic aciduria

Martinelli

Catesini

Greco

et al. 2023

J of Inher Metab Disea

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Liver and liver/kidney transplantation are increasingly used in methylmalonic aciduria, but little is known on their impact on CNS. The effect of transplantation on neurological outcome was prospectively assessed in six patients preand post-transplant by clinical evaluation and by measuring disease biomarkers in plasma and CSF, in combination with psychometric tests and brain MRI studies. Primary (methylmalonic-and methylcitric acid) and secondary biomarkers (glycine and glutamine) significantly improved in plasma, while they remained unchanged in CSF. Differently, biomarkers of mitochondrial dysfunction (lactate, alanine, and related ratios) significantly decreased in CSF. Neurocognitive evaluation documented significant higher post-transplant developmental/cognitive scores and maturation of executive functions corresponding to improvement of brain atrophy, cortical thickness, and white matter maturation indexes at MRI. Three patients presented post-transplantation reversible neurological events, which were differentiated, by means of

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Differences in the Incidence and Clinical Evolution of Early Neurotoxicity After Liver Transplantation Based on Tacrolimus Formulation Used in the Immunosuppressive Induction Protocol

Cited by 10 publications

References 9 publications

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Neurotoxicity including posterior reversible encephalopathy syndrome after initiation of calcineurin inhibitors in transplanted methylmalonic acidemia patients: Two case reports and review of the literature

Neurologic outcome following liver transplantation for methylmalonic aciduria

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