Tacrolimus‐related seizure after pediatric liver transplantation – A single‐center experience

Abstract

To identify the risk factors for new-onset seizures after pediatric LT and to assess their clinical implications and long-term prognosis. The clinical and laboratory data of 27 consecutive children who underwent LT from January 2007 to December 2010 in our center were analyzed retrospectively. Patients were divided into seizures group and a non-seizures group. Pre-operative, intra-operative, and post-operative data were collected. Seizures occurred in four children, an incidence of 14.8%. All exhibited generalized tonic-clonic seizures within the first two wk after LT. Univariate analysis showed that the risk factors associated with seizures after pediatric LT included gender, pediatric end-stage liver disease score before surgery, Child-Pugh score before surgery, serum total bilirubin after surgery, and trough TAC level. Multivariate analysis showed that trough TAC level was the only independent risk factor associated with the seizures. All children who experienced seizures survived with good graft function and remained seizure-free without anti-epileptic drugs over a mean follow-up period of 33.7 ± 14.6 months. High trough TAC level was the predominant factor that contributed to seizures in the early post-operative period after pediatric LT. High PELD and Child-Pugh scores before LT and high post-operative serum Tbil may be contributory risk factors for TAC-related seizures.

Early post‐transplant hyperbilirubinemia is a possible predictive factor for developing neurological complications in pediatric living donor liver transplant patients receiving tacrolimus

“…Although our study population was limited, our results showed that early post‐transplant hyperbilirubinemia in children who were given oral TAC is positively correlated with the development of CNI‐NCs. In support of our findings, a similar trend was seen in other studies involving both small number pediatric and large number adult populations . Hyperammonemia is also reported to alter the BBB.…”

“…In contrast, no infants under 1 year of age developed CNI‐NCs in the current study, despite comprising nearly half of the patients. Accordingly, except for NCs associated with primary disease, cerebral hemorrhage, hypoxia‐ischemic injury, or infection, CNI‐NCs in LT infants below 1 year are extremely rare in other reports as well . The reason for this result is not clear, but it is possible that the permeability of the BBB and/or brain tissue itself in infants is not amenable to the development of CNI‐NCs.…”

Seizures after transplantation

“…Only two of the patients showed SE or focal awareness impaired seizure, and the others were characterized as GTCSs. Xie et al [54] conducted a singlecenter retrospective study and found that of 27 pediatric recipients of liver transplantation, four patients showed seizures in the first two weeks after transplantation, and the seizures were all characterized as GTCSs. However, Kılıç et al [55] collected statistics from 28 pediatric patients and found that focal seizures were more common than generalized seizures.…”

“…Wszolek et al [51] found that there are two peaks of seizure occurrence after transplantation, namely, the first week and the fifth to sixteenth weeks after surgery. Adult patients usually experience seizures in the early postoperative period [51,[53][54][55][56]. Xie et al [54] found that pediatric patients often show seizures within the first two weeks after liver transplantation; this idea was supported by Kılıç et al [55].…”

“…Adult patients usually experience seizures in the early postoperative period [51,[53][54][55][56]. Xie et al [54] found that pediatric patients often show seizures within the first two weeks after liver transplantation; this idea was supported by Kılıç et al [55]. Moreover, Ghosh et al [56] analyzed the data of 65 pediatric recipients of liver transplantation and found that most seizures occur within three months after transplantation.…”