The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation.
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.
Zivković
Sasa A
SA
The VA Pittsburgh Healthcare System and The Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15240, USA. sasa.zivkovic@va.gov
Eidelman
Benjamin H
BH
Bond
Geoffrey
G
Costa
Guilherme
G
Abu-Elmagd
Kareem M
KM
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
D007166:Immunosuppressive Agents; D016559:Tacrolimus