title: Two Cases With Developing Neurologic Complications After Liver Transplant.
abstract: The widespread use of immunosuppressive agents has significantly increased the rates of successful solid-organ and stem cell transplants, especially with liver and kidney. Cyclosporine and tacrolimus are most commonly used for this purpose. Although these agents have different mechanisms of action, both have various adverse effects, including nausea, vomiting, headache, hypertension, nephrotoxicity, and rarely epileptic seizures. In our first case, a patient presented with epileptic seizures and hemiparesis after a liver transplant, and posterior reversible encephalopathy syndrome related to cyclosporine toxicity was considered. Once cyclosporine levels in the blood decreased, the patient had both clinical and radiologic improvements. In our second case, a patient presented with delirium after a liver transplant. Again, when cyclosporine levels in the blood decreased, the patient showed improvement in clinical findings. Neurologic complications may develop after liver transplant, and these complications are encountered most frequently within the first postoperative month. Neurologic complications are multifactorial; insufficient graft function, intracranial bleeding, cerebral infarcts, infections, and immunosuppressive drug toxicity (tacrolimus and cyclosporine) may be considered among these factors. As shown in our presented cases, most neurologic complications can be successfully treated by correcting the underlying factor.
authors.affiliation: Department of Neurology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Bican Demir
authors.forename: Sevda
authors.initials: S
authors.lastname: Erer Özbek
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bora
authors.forename: Bahattin
authors.initials: B
authors.lastname: Hakyemez
authors.forename: Ismail
authors.initials: I
authors.lastname: Tırnova
authors.forename: Ekrem
authors.initials: E
authors.lastname: Kaya
mesh_terms: D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008107:Liver Diseases / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects; D008875:Middle Aged; D018908:Muscle Weakness / Q000188:drug therapy / Q000209:etiology*; D010291:Paresis / Q000209:etiology*; D011183:Postoperative Complications; D001405:Reflex, Babinski; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus