title: Neurological complications after liver transplantation as a consequence of immunosuppression: univariate and multivariate analysis of risk factors.
abstract: Neurological complications (NCs) can frequently and significantly affect morbidity and mortality of liver transplant (LT) recipients. We analysed incidence, risk factors, outcome and impact of the immunosuppressive therapy on NC development after LT. We analysed 478 LT in 440 patients, and 93 (19.5%) were followed by NCs. The average LOS was longer in patients experiencing NCs. The 1-, 3- and 5-year graft survival and patient survival were similar in patients with or without a NC. Multivariate analysis showed the following as independent risk factors for NC: a MELD score ≥20 (OR = 1.934, CI = 1.186-3.153) and an immunosuppressive regimen based on calcineurin inhibitors (CNIs) (OR = 1.669, CI = 1.009-2.760). Among patients receiving an everolimus-based immunosuppression, the 7.1% developed NCs, vs. the 16.9% in those receiving a CNI (P = 0.039). There was a 1-, 3- and 5-year NC-free survival of 81.7%, 81.1% and 77.7% in patients receiving a CNI-based regimen and 95.1%, 93.6% and 92.7% in those not receiving a CNI-based regimen (P < 0.001). In patients undergoing a LT and presenting with nonmodifiable risk factors for developing NCs, an immunosuppressive regimen based on CNIs is likely to result in a higher rate of NCs compared to mTOR inhibitors.
authors: Liver Transplant Centre, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Gianluca
authors: G
authors: Rompianesi
authors: Liver Transplant Centre, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Roberto
authors: R
authors: Montalti
authors: Liver Transplant Centre, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Nicola
authors: N
authors: Cautero
authors: Liver Transplant Centre, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Nicola
authors: N
authors: De Ruvo
authors: Institute of Liver Studies, King's College Hospital, London, UK.
authors: Anthony
authors: A
authors: Stafford
authors: General Surgery, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Carolina
authors: C
authors: Bronzoni
authors: Liver Transplant Centre, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Roberto
authors: R
authors: Ballarin
authors: Division of Anaesthesiology and Intensive Care Unit, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Lesley
authors: L
authors: De Pietri
authors: Liver Transplant Centre, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Fabrizio
authors: F
authors: Di Benedetto
authors: General Surgery, Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy.
authors: Giorgio E
authors: GE
authors: Gerunda
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D000068338:Everolimus / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000276:immunology*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: calcineurin inhibitors; immunosuppression; liver transplantation; mTOR inhibitors; neurological complications