Acute cyclosporine toxicity after liver transplantation is predicted by the lidocaine monoethylglycinexylidide test in the donor.
Cyclosporine toxicity is still a significant problem in the early period after liver transplantation. The monoethylglycinexylidide (MEGX) test performed in the donor has been suggested as a reliable test to predict liver graft function in the recipient. The MEGX test was performed in 50 consecutive donors, and the clinical course of recipients, metabolic parameters of the grafts, and cyclosporine levels were followed in detail for 10 days. Two patients died of sepsis and were excluded. Renal and/or neurological toxicity appeared in 15 of the remaining 48 patients (31%). In the 6 with neurological problems, MEGX values were low (41, 47, 50, 60, 94, and 101 micrograms/L). Nine patients had transient elevations of creatinine and urea; in 8 of these, cyclosporine levels remained in the normal range. Low MEGX values in the donors correlated with early evidence of cyclosporine toxicity (P < .0001), reduced graft function (bile output, P = .04; prothrombin time at day 5, P = .005), and prolonged stay in the intensive care (P = .022). The MEGX test is valuable and reflects the metabolic capacity of liver grafts. It can predict posttransplantation complications caused by cyclosporine toxicity, and further study would evaluate its incorporation into immunosuppressive protocols.
Azoulay
D
D
Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
Adam
R
R
Pham
P
P
Salvucci
M
M
Davoll
S
S
Bismuth
H
H
Debuire
B
B
Lemoine
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D008012:Lidocaine / Q000031:analogs & derivatives*; D008111:Liver Function Tests / Q000379:methods*; D016031:Liver Transplantation / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000139:chemically induced; D011379:Prognosis; D011446:Prospective Studies; D014019:Tissue Donors
D016572:Cyclosporine; D008012:Lidocaine; C001173:monoethylglycinexylidide