title: Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: a single-center study.
abstract: BACKGROUND
  Central pontine and extrapontine myelinolysis (CPM/EPM) are severe neurologic complications after liver transplantation.
  
  
  METHODS
  The present work retrospectively evaluated single-center prevalence of CPM/EPM and associated risk factors: cause of liver disease, hepatic encephalopathy, preoperative, intraoperative, and perioperative blood components use, serum levels, and variation of Na, Cl, and K and immunosuppression were compared between CPM/EPM patients and control group of transplanted patients without neurologic complications.
  
  
  RESULTS
  Among 997 transplants, CPM/EPM were diagnosed in 11 patients (1.1%), of whom four were CPM, one was EPM, and six were associated CPM and EPM. Control group consisted of 44 transplanted patients. Central pontine and extrapontine myelinolysis patients experienced higher intraoperative and perioperative serum Na/24 hr variations compared to controls (16.69 ± 5.17 vs. 9.8 ± 3.4 mEq/L, P = 0.001). Maximum peak of intraoperative or perioperative serum Na was significantly higher in patients compared to controls (151.5 ± 3.3 vs. 140.8 ± 6.2 mEq/L, P ≤ 0.001), but no difference in preoperative serum Na was detected. Three patients presented hypernatremia as isolated risk factor.
  
  
  CONCLUSIONS
  Extrapontine myelinolysis can be found isolated or associated with CPM in up to two of three liver transplanted patients with myelinolysis. A marked variation of perioperative serum Na remains the main risk factor even in patients without preexisting hyponatremia; however, isolated hypernatremia may be solely responsible in some cases.
authors.affiliation: 1 Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy. 2 Department of Neurosciences, Sciences NPSRR, University Hospital of Padua, Padua, Italy. 3 IRCCS San Camillo Foundation, Venice, Italy. 4 Department of Neuroradiology, University of Salerno, Salerno, Italy. 5 Hepatobiliary Surgery and Liver Transplant Center, University Hospital of Padua, Padua Italy. 6 Operative Unit of Anesthesia and Intensive Care, Department of Medicine, University Hospital of Padua, Padua, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Crivellin
authors.forename: Annachiara
authors.initials: A
authors.lastname: Cagnin
authors.forename: Renzo
authors.initials: R
authors.lastname: Manara
authors.forename: Patrizia
authors.initials: P
authors.lastname: Boccagni
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Stefania
authors.initials: S
authors.lastname: Barbieri
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrarese
authors.forename: Giacomo
authors.initials: G
authors.lastname: Germani
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Russo
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000150:complications; D007010:Hyponatremia / Q000097:blood / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood
chemical_list: D012964:Sodium