Mellado Patricio, Peredo Pilar, Valenzuela Raúl, Arrese Marco, Pérez Rosa María, Domínguez Pilar, Guerra Juan Francisco, Jarufe Nicolás, Martínez Jorge
Departamento de Neurología, Hospital Clínico, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2008 Oct;136(10):1255-63. Epub 2009 Jan 15.
Orthotopic liver transplantation (OLT) is the treatment of choice for multiple acute and chronic end-stage liver diseases as well as for selected cases of liver malignancy and liver-site metabolic disorders. Neurological impairment is a major source of morbidity and mortality following OLT.
To describe the incidence and the type of neurological complications occurring in the post-operative period of OLT in patients transplanted in our hospital.
Between March 1994 and August 2007, 76 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications have been obtained from our program data base and patient charts.
Twenty three patients (30.3%) had CNS complications following OLT. The leading complications were immunosuppressive drug-related neurological impairment in nine patients (39.1%), peripheral nerve damage in five patients (21.7%), central pontine myelinolysis in four patients (17.4%), cerebrovascular disease in three (13%) and CNS infection in three (13%). Most CNS events (90%) occurred in the first 2 weeks after OLT. Five patients with neurological complications died (22%).
CNS complications occurred in almost one fifth of the population studied, and they had a poor outcome, as previously reported).
原位肝移植(OLT)是多种急慢性终末期肝病以及某些肝脏恶性肿瘤和肝脏部位代谢紊乱病例的首选治疗方法。神经功能障碍是OLT术后发病和死亡的主要原因。
描述我院接受移植的患者OLT术后发生的神经并发症的发生率和类型。
1994年3月至2007年8月,76例成年患者接受了OLT。关于中枢神经系统(CNS)并发症的发生率、发病时间和结局的数据已从我们的项目数据库和患者病历中获取。
23例患者(30.3%)OLT术后发生CNS并发症。主要并发症为9例(39.1%)免疫抑制药物相关神经功能障碍、5例(21.7%)周围神经损伤、4例(17.4%)中枢桥脑髓鞘溶解、3例(13%)脑血管疾病和3例(13%)CNS感染。大多数CNS事件(90%)发生在OLT后的前2周。5例有神经并发症的患者死亡(22%)。
在所研究的人群中,近五分之一发生了CNS并发症,且结局不佳,如先前报道的那样。