Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation.
In a recent series of 44 liver transplants we identified both extrapontine myelinolysis (EPM) - characteristic of cyclosporine neurotoxicity - and central pontine myelinolysis (CPM) in 5 recipients posttransplant. An additional 2 recipients had EPM only posttransplant. MRIs performed in 4 asymptomatic recipients were normal. Large perioperative shifts in serum sodium, hypomagnesemia, and high cyclosporine levels may play a role in the development of these lesions, although the evidence from this study is inconclusive. In addition to supportive care, dilantin was started in patients who had seizures; aggressive magnesium replacement was initiated for hypomagnesemia, and cyclosporine levels were reduced in all patients. All patients demonstrated a slow steady recovery and all but 2 are at home at the time of writing. CPM may be more prevalent than previously appreciated following liver transplantation, although its prognosis may not be as dismal.
Fryer
J P
JP
Multiorgan Transplant Service, University Hospital, University of Western Ontario, London, Canada.
Fortier
M V
MV
Metrakos
P
P
Verran
D J
DJ
Asfar
S K
SK
Pelz
D M
DM
Wall
W J
WJ
Grant
D R
DR
Ghent
C N
CN
D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D003711:Demyelinating Diseases / Q000209:etiology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008274:Magnesium / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000097:blood / Q000139:chemically induced / Q000209:etiology*; D011149:Pons / Q000187:drug effects / Q000473:pathology; D012964:Sodium / Q000097:blood
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D002784:Cholesterol; D012964:Sodium; D008274:Magnesium