Leukoencephalopathy syndrome after living-donor liver transplantation

Yuzo Umeda, Hiroaki Matsuda, Hiroshi Sadamori, Susumu Shinoura, Ryuichi Yoshida, Daisuke Sato, Masashi Utsumi, Takahito Yagi, Toshiyoshi Fujiwara

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Leukoencephalopathy syndrome is a neurologic complication after organ transplantation caused predominantly by the neurotoxic effects of immunosuppressive agents on cerebral white matter. We determined the incidence and features of leukoencephalopathy syndrome in recipients after living-donor liver transplantations. Materials and Methods: We retrospectively investigated 205 patients who had a living-donor liver transplantation performed at our institution between August 1998 and October 2008. Results: Leukoencephalopathy syndrome developed in 7 of 205 patients (3.9%) and in 4.7% of the 150 patients treated with tacrolimus-based immuno - suppression after their living-donor liver transplantation. The underlying diseases were alcoholic cirrhosis in 3 cases, viral cirrhosis in 2, biliary atresia in 1, and Wilson disease in 1. Time to clinical onset after tacrolimus medication was 15.6 days (range, 6-30 days). The neurologic symptoms included headache, confusion, myoclonus, seizures, and visual disturbances. The mean serum trough level of tacrolimus at clinical onset was not very high (11.7 ng/mL [range, 6.0-14.2 ng/mL]). T2-weighted magnetic resonance imaging in all cases showed diffuse high signal in the white matter of the frontal, parieto-occipital, and temporal lobes. Treatment with antihypertensives, anticonvulsants, and withdrawal of tacrolimus resulted in amelioration of symptoms and magnetic resonance imaging abnormalities. Six patients showed complete recovery, while the seventh had residual rigidity and cognitive impairment caused by hypoxia during a convulsion. Conclusions: Tacrolimus neurotoxicity can occur despite low trough levels; it depends on variations in pharmacokinetics, such as absorption and maximum concentration level. Early diagnosis and treatment of leukoencephalopathy syndrome should contribute to complete remission.

Original languageEnglish
Pages (from-to)139-144
Number of pages6
JournalExperimental and Clinical Transplantation
Volume9
Issue number2
Publication statusPublished - Apr 2011

Fingerprint

Leukoencephalopathies
Living Donors
Tacrolimus
Liver Transplantation
Seizures
Magnetic Resonance Imaging
Biliary Atresia
Alcoholic Liver Cirrhosis
Occipital Lobe
Confusion
Hepatolenticular Degeneration
Myoclonus
Organ Transplantation
Temporal Lobe
Immunosuppressive Agents
Neurologic Manifestations
Anticonvulsants
Antihypertensive Agents
Nervous System
Headache

Keywords

  • Complication
  • Liver transplantation
  • Neurotoxicity
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation

Cite this

Leukoencephalopathy syndrome after living-donor liver transplantation. / Umeda, Yuzo; Matsuda, Hiroaki; Sadamori, Hiroshi; Shinoura, Susumu; Yoshida, Ryuichi; Sato, Daisuke; Utsumi, Masashi; Yagi, Takahito; Fujiwara, Toshiyoshi.

In: Experimental and Clinical Transplantation, Vol. 9, No. 2, 04.2011, p. 139-144.

Research output: Contribution to journalArticle

Umeda, Yuzo ; Matsuda, Hiroaki ; Sadamori, Hiroshi ; Shinoura, Susumu ; Yoshida, Ryuichi ; Sato, Daisuke ; Utsumi, Masashi ; Yagi, Takahito ; Fujiwara, Toshiyoshi. / Leukoencephalopathy syndrome after living-donor liver transplantation. In: Experimental and Clinical Transplantation. 2011 ; Vol. 9, No. 2. pp. 139-144.
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AU - Sadamori, Hiroshi

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AU - Yoshida, Ryuichi

AU - Sato, Daisuke

AU - Utsumi, Masashi

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AB - Objectives: Leukoencephalopathy syndrome is a neurologic complication after organ transplantation caused predominantly by the neurotoxic effects of immunosuppressive agents on cerebral white matter. We determined the incidence and features of leukoencephalopathy syndrome in recipients after living-donor liver transplantations. Materials and Methods: We retrospectively investigated 205 patients who had a living-donor liver transplantation performed at our institution between August 1998 and October 2008. Results: Leukoencephalopathy syndrome developed in 7 of 205 patients (3.9%) and in 4.7% of the 150 patients treated with tacrolimus-based immuno - suppression after their living-donor liver transplantation. The underlying diseases were alcoholic cirrhosis in 3 cases, viral cirrhosis in 2, biliary atresia in 1, and Wilson disease in 1. Time to clinical onset after tacrolimus medication was 15.6 days (range, 6-30 days). The neurologic symptoms included headache, confusion, myoclonus, seizures, and visual disturbances. The mean serum trough level of tacrolimus at clinical onset was not very high (11.7 ng/mL [range, 6.0-14.2 ng/mL]). T2-weighted magnetic resonance imaging in all cases showed diffuse high signal in the white matter of the frontal, parieto-occipital, and temporal lobes. Treatment with antihypertensives, anticonvulsants, and withdrawal of tacrolimus resulted in amelioration of symptoms and magnetic resonance imaging abnormalities. Six patients showed complete recovery, while the seventh had residual rigidity and cognitive impairment caused by hypoxia during a convulsion. Conclusions: Tacrolimus neurotoxicity can occur despite low trough levels; it depends on variations in pharmacokinetics, such as absorption and maximum concentration level. Early diagnosis and treatment of leukoencephalopathy syndrome should contribute to complete remission.

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