Tacrolimus-Related Neurologic and Renal Complications in Liver Transplantation: A Single-Center Experience

• Published in: Transplantation proceedings Vol. 38; no. 2; pp. 619 - 621
• Main Authors: Emiroglu, R., Ayvaz, I., Moray, G., Karakayali, H., Haberal, M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2006; Elsevier Science
• Subjects: Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Cyclosporine - therapeutic use; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatolenticular Degeneration - surgery; Humans; Immunosuppressive Agents - adverse effects; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Medical sciences; Nervous System Diseases - chemically induced; Nervous System Diseases - epidemiology; Pharmacology. Drug treatments; Postoperative Complications - epidemiology; Postoperative Complications - immunology; Psychotic Disorders - etiology; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tacrolimus - adverse effects; Tissue, organ and graft immunology; Center; Calcineurin inhibitor; Digestive system; Liver; Lactone; Homotransplantation; Macrolide; Kidney; Immunomodulator; Medicine; Experience; Treatment; Urinary system; Tacrolimus; Surgery; Complication; Graft; Immunosuppressive agent; Antibacterial agent; Kidney transplantation
• DOI: 10.1016/j.transproceed.2005.12.114
• ISSN: 0041-1345

Among 71 patients, 19 (26.7%) experienced tacrolimus-related complications including 15 neurologic reactions and four problems with nephrotoxicity. Seven of these patients received grafts from cadaveric donors and 12 from living donors. Nine patients were children. The cohort included 5 female and 14 male subjects of mean age 26 ± 20 (min 6, max 65) years. The common indications for the liver transplantation were cholestatic and metabolic diseases in pediatric patients, and viral hepatitis in adult patients. Blood tacrolimus levels were within the normal range. All patients with neurologic complications received antiepileptic therapy and drug conversion to rapamycin in 4 cases and to cyclosporine (CsA) in 11 cases. Six cases with Wilson disease and all cases with tyrosinemia experienced neurologic complications, which reversed in all but one case. In four cases with nephrotoxicity, we switched to rapamycin. Renal function improved in all cases. Patients with Wilson disease and tyrosinemia were more susceptible to the neurologic side effects of tacrolimus. In these cases we recommend the use of drugs with fewer neurologic side effects. Tacrolimus also has nephrotoxic effects, which can be reversed by converting to rapamycin.