Heidenhain Christoph, Puhl Gero, Neuhaus Peter
Klinik fur Allgemein-, Viszeral- und Transplantschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Exp Clin Transplant. 2009 Sep;7(3):180-3.
Posterior leukoencephalopathy due to calcineurin-inhibitor-related neurotoxicity is a rare but severe complication that results from treatment with immunosuppressive agents (primarily those administered after a liver or kidney transplant). The pathophysiologic mechanisms of that disorder remain unknown.
We report the case of a 46-year-old woman who received a liver transplant in our center as treatment for alcoholic cirrhosis and in whom either a fulminant course of posterior leukoencephalopathy or posterior reversible encephalopathy syndrome developed 110 days after transplant. After an initially uneventful course after the transplant, the patient rapidly fell into deep coma.
Cerebral MRI scan showed typical signs of enhancement in the pontine and posterior regions. Switching the immunosuppressive regimen from tacrolimus to cyclosporine did not improve the clinical situation. The termination of treatment with any calcineurin inhibitor resulted in a complete resolution of that complication.
Posterior reversible encephalopathy syndrome after liver transplant is rare. We recommend a complete cessation of any calcineurin inhibitor rather than a dose reduction.
由钙调神经磷酸酶抑制剂相关神经毒性引起的后部白质脑病是一种罕见但严重的并发症，它是由免疫抑制剂治疗（主要是肝或肾移植后使用的药物）导致的。该疾病的病理生理机制尚不清楚。
我们报告了一名46岁女性的病例，她在我们中心接受肝移植以治疗酒精性肝硬化，在移植后110天出现了暴发性后部白质脑病或后部可逆性脑病综合征。移植后最初病情平稳，但患者迅速陷入深度昏迷。
脑部MRI扫描显示脑桥和后部区域有典型的强化迹象。将免疫抑制方案从他克莫司改为环孢素并没有改善临床状况。停用任何钙调神经磷酸酶抑制剂后，该并发症完全缓解。
肝移植后后部可逆性脑病综合征很罕见。我们建议完全停用任何钙调神经磷酸酶抑制剂，而不是减少剂量。
