The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation

Clin Transplant. 2010 Mar-Apr;24(2):164-8. doi: 10.1111/j.1399-0012.2009.01065.x. Epub 2009 Aug 24.

Abstract

Background: Intestinal transplantation has evolved into an effective therapy for patients with intestinal failure and the inability to be maintained on total parenteral nutrition. Long-term heavy immunosuppression and complex systemic disturbances increase the risk of the neurologic complications.

Methods: This retrospective analysis identified the post-transplant neurologic complications in adult patients who underwent intestinal transplantation at the University of Pittsburgh Medical Center between May 1990 and August 1998. The recipients received 28 isolated intestine, 17 composite liver-intestine, and nine multivisceral allografts.

Results: With a median follow-up of 25 months, 46 of 54 recipients (68%) developed headaches (n = 27; 50%), encephalopathy (n = 23; 43%), seizures (n = 9; 17%), neuromuscular disorders (n = 4; 7%), opportunistic CNS infections (n = 4; 7%), and ischemic stroke (n = 2; 4%).

Conclusions: Under high maintenance immunosuppression, intestinal transplant recipients were at high risk for neurologic complications. Future studies are needed to describe post-transplant neurologic complications with modern immunosuppression protocols.

MeSH terms

  • Adult
  • Female
  • Headache / etiology
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Intestines / transplantation*
  • Liver Transplantation
  • Male
  • Middle Aged
  • Nervous System Diseases / etiology*
  • Retrospective Studies
  • Stroke / etiology
  • Tacrolimus / adverse effects
  • Transplantation, Homologous
  • Viscera / transplantation
  • Young Adult

Substances

  • Immunosuppressive Agents
  • Tacrolimus