Donor age predicts calcineurin inhibitor induced neurotoxicity after liver transplantation

Lué, A (Universidad de Zaragoza) ; Martinez, E ; Navarro, M ; Laredo, V ; Lorente, S (Universidad de Zaragoza) ; Araiz, JJ (Universidad de Zaragoza) ; Garcia-Gil, FA (Universidad de Zaragoza) ; Serrano, MT (Universidad de Zaragoza)

Resumen: 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 analysed 175 LT performed at our centre between January 2010 and September 2016. Donor and recipient demographics as well as clinical variables pre-, intra-, 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 (OR 2.728, 95%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 year 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).
Conclusion: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.

Idioma: Inglés

DOI: 10.1097/TP.0000000000002750

Año: 2019

Publicado en: Transplantation 103, 8 (2019), 211-215
ISSN: 0041-1337

Factor impacto JCR: 4.264 (2019)

Categ. JCR: SURGERY rank: 21 / 209 = 0.1 (2019) - Q1 - T1
Categ. JCR: TRANSPLANTATION rank: 6 / 24 = 0.25 (2019) - Q1 - T1
Categ. JCR: IMMUNOLOGY rank: 52 / 158 = 0.329 (2019) - Q2 - T1

Factor impacto SCIMAGO: 1.696 - Transplantation (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Cirugía (Dpto. Cirugía,Ginecol.Obstetr.)
Área (Departamento): Área Psicolog.Evolut.Educac (Dpto. Psicología y Sociología)