title: The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation.
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.
authors.affiliation: The VA Pittsburgh Healthcare System and The Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15240, USA. sasa.zivkovic@va.gov
authors.forename: Sasa A
authors.initials: SA
authors.lastname: Zivković
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Eidelman
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bond
authors.forename: Guilherme
authors.initials: G
authors.lastname: Costa
authors.forename: Kareem M
authors.initials: KM
authors.lastname: Abu-Elmagd
mesh_terms: D000328:Adult; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D016559:Tacrolimus / Q000009:adverse effects; D014184:Transplantation, Homologous; D014781:Viscera / Q000637:transplantation; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus