Successful Conversion to Rapamycin for Calcineurin Inhibitor-Related Neurotoxicity Following Liver Transplantation

Forgács, B.; Merhav, Hadar; Lappin, Jacqueline; Mieles, Luis

doi:10.1016/j.transproceed.2005.02.101

Cited by 63 publications

(43 citation statements)

References 13 publications

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“…It is therefore possible that a longer period of follow-up may have detected clinically relevant differences between the two groups, such as symptoms and clinical signs of peripheral neuropathy. These findings are consistent with larger cohort studies that have demonstrated that treatment with sirolimus and mycophenolate is not associated with significant neurotoxicity (28,29).…”

Section: Discussionsupporting

confidence: 91%

Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients

Arnold

Pussell

Pianta

et al. 2013

American Journal of Transplantation

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Neurotoxicity is a significant clinical side effect of immunosuppressive treatment used in prophylaxis for rejection in solid organ transplants. This study aimed to provide insights into the mechanisms underlying neurotoxicity in patients receiving immunosuppressive treatment following renal transplantation. Clinical and neurophysiological assessments were undertaken in 38 patients receiving immunosuppression following renal transplantation, 19 receiving calcineurin inhibitor (CNI) therapy and 19 receiving a calcineurin-free (CNI-free) regimen. Groups were matched for age, gender, time since transplant and renal function and compared to normal controls (n ¼ 20). The CNI group demonstrated marked differences in nerve excitability parameters, suggestive of nerve membrane depolarization (p < 0.05). Importantly, there were no differences between the two CNIs (cyclosporine A or tacrolimus). In contrast, CNI-free patients showed no differences to normal controls. The CNI-treated patients had a higher prevalence of clinical neuropathy and higher neuropathy severity scores. Longitudinal studies were undertaken in a cohort of subjects within 12 months of transplantation (n ¼ 10). These studies demonstrated persistence of abnormalities in patients maintained on CNI-treatment and improvement noted in those who were switched to a CNI-free regimen. The results of this study have significant implications for selection, or continuation, of immunosuppressive therapy in renal transplant recipients, especially those with pre-existing neurological disability.

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Section: Discussionsupporting

confidence: 91%

Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients

Arnold

Pussell

Pianta

et al. 2013

American Journal of Transplantation

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“…All patients showed improvement or resolution of their neurological symptoms after switching the drug to rapamycin. Forgacs et al 7 reported that there were no complications directly attributed to rapamycin. Rapamycin can be safely used in orthotopic liver transplantation recipients with severe neurological symptoms ascribed to or exacerbated by CNIs.…”

Section: Discussionmentioning

confidence: 99%

“…Rapamycin can be safely used in orthotopic liver transplantation recipients with severe neurological symptoms ascribed to or exacerbated by CNIs. 3,4,7 The aim of this article was to present a renal transplant patient with PNP due to use of CsA and with improvement when switched to rapamycin.…”

Section: Introductionmentioning

confidence: 99%

Polyneuropathy Due to Cyclosporine A in Patients with Renal Transplantation: A Case Report

2011

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Background: Calcineurin inhibitor cyclosporine A (CsA) is a potent immunosuppressive agent. The side effects of CsA include nephrotoxicity, hypertension, hypertrichosis, infection, hyperpotassemia, and, to a lower extent, neuropathy. Objectives: In this case report, we aimed to present a renal transplant patient with polyneuropathy (PNP) due to the use of CsA and with improvement when switched to rapamycin. Methods: In electromyography, axonal sensory PNP was detected. CsA was stopped and rapamycin was begun. Results: His complaints rapidly improved after using rapamycin. Conclusions: Patients using CsA should be closely monitored for peripheral neuropathy and in case of toxicity, alternative immunosuppressive agents should be considered.

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“…These drugs effectively prevent acute rejection episodes and significantly prolong patient and graft survival [2,3]. As demonstrated in large, prospective, randomized, multicenter solid organ transplantation (SOT) trials, when compared with CsA, TAC further reduced the 6-month/ 1-year incidence of biopsy-proven acute rejection.…”

Section: Introductionmentioning

confidence: 99%

“…Mild symptoms include tremor, neuralgia, and peripheral neuropathy. Severe symptoms could be manifested as psychoses, hallucinations, cortical blindness, seizures, cerebellar ataxia, motor weakness, or posterior reversible encephalopathy syndrome (PRES) [2,9,10,11,12,13,14,15]. As an uncommon complication related to significant morbidity and mortality if it is not expeditiously recognized [9], TAC-associated PRES after SOT has recently been increasingly reported.…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome after Solid Organ Transplantation

Wu¹,

et al. 2010

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Tacrolimus (TAC) is an immunosuppressant drug discovered in 1984 by Fujisawa Pharmaceutical Co., Ltd. This drug belongs to the group of calcineurin inhibitors, which has been proven highly effective in preventing acute rejection after transplantation of solid organs. However, neurotoxicity and nephrotoxicity are its major adverse effects. Posterior reversible encephalopathy syndrome (PRES) is the most severe and dramatic consequence of calcineurin inhibitor neurotoxicity. It was initially described by Hinchey et al. in 1996 [N Engl J Med 1996;334:494–450]. Patients typically present with altered mental status, headache, focal neurological deficits, visual disturbances, and seizures. Magnetic resonance imaging is the most sensitive imaging test to detect this. With the more deep-going studies done recently, we have learnt more about this entity. It was noted that this syndrome is frequently reversible, rarely limited to the posterior regions of the brain, and often located in gray matter and cortex as well as in white matter. Therefore, in this review, the focus is on the current understanding of clinical recognition, pathogenesis, neuroimaging and management of TAC-associated PRES after solid organ transplantation.

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Successful Conversion to Rapamycin for Calcineurin Inhibitor-Related Neurotoxicity Following Liver Transplantation

Cited by 63 publications

References 13 publications

Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients

Association Between Calcineurin Inhibitor Treatment and Peripheral Nerve Dysfunction in Renal Transplant Recipients

Polyneuropathy Due to Cyclosporine A in Patients with Renal Transplantation: A Case Report

Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome after Solid Organ Transplantation

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