Early post-transplant hyperbilirubinemia is a possible predictive factor for developing neurological complications in pediatric living donor liver transplant patients receiving tacrolimus.
The cause of post-transplant CNI-NCs is multifactorial and not ascribed solely to CNI toxicity. A total of 90 children (aged <20 years) who underwent LDLT were evaluated to investigate the predictive factors associated with CNI-NCs. Twelve patients (13.3%) developed CNI-NCs after LDLT (age range, 2-15 years). The symptoms of CNI-NCs were seizures, VD, and stupor. The median onset of CNI-NCs was 10 days (range, 5-30 days) post-transplant. In the univariate analysis, higher recipient age at LDLT, donor age and recipient's BW, lower actual GV/SLV and TAC dosage/BW, and higher mean T-Bil and sodium level for 7 days after transplantation were independently significantly associated with TAC-NCs. Multivariate analysis showed that the T-Bil level in the first week after LDLT was the only significant independent predictive factor for TAC-NCs (HR, 1.588; 95% CI, 1.042-2.358; P=.031). In conclusion, CNI-NCs occurred most frequently in children over 5 years and were associated with hyperbilirubinemia for 7 days post-transplant, regardless of TAC levels. The transplant team should refer to a neurologist to define the diagnosis and to collaborate to resolve the neurological problems.
Department of general medicine, Tosendo Hospital, Wakuya, Japan.|Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Kazushige
K
Sato
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Yoshinobu
Y
Kobayashi
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Atsushi
A
Nakamura
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Daizo
D
Fukushima
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Susumu
S
Satomi
D000293:Adolescent; D017668:Age of Onset; D001663:Bilirubin / Q000032:analysis; D001835:Body Weight; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications* / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000150:complications* / Q000175:diagnosis*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D053608:Stupor / Q000150:complications; D016559:Tacrolimus / Q000009:adverse effects*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D001663:Bilirubin; D016559:Tacrolimus
bilirubin; calcineurin inhibitor; children; liver transplantation; neurological complications