Stracciari Andrea, Guarino Maria
Neurology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Neurology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Handb Clin Neurol. 2014;121:1267-76. doi: 10.1016/B978-0-7020-4088-7.00086-9.
Intestinal transplantation has become a life-saving therapy in patients with irreversible loss of intestinal function and complications of total parenteral nutrition, but it entails a high incidence of neurologic complications, which occur more frequently than in other solid organ transplantations. Neurologic complications may be surgery-related or occur postoperatively, often within the first month. The etiology is various, often multifactorial, immunosuppression being one of the leading causes as intestine transplant recipients usually need potent immunosuppressive regimens. Neurologic problems after intestinal transplantation may present with a wide clinical spectrum, mainly mild to severe central nervous system disorders. Awareness of these complications is crucial for patients' survival, since it will assist clinicians in prevention, prompt diagnosis, and treatment. This survey tackles the most common neurologic disorders and presents practice points of management which can help in the daily clinical care of intestinal transplant recipients.
肠道移植已成为肠道功能不可逆丧失且出现全胃肠外营养并发症患者的一种挽救生命的治疗方法,但它会引发较高发生率的神经并发症,其发生频率高于其他实体器官移植。神经并发症可能与手术相关或在术后出现,通常在第一个月内。病因多种多样,往往是多因素的,免疫抑制是主要原因之一,因为肠道移植受者通常需要强效的免疫抑制方案。肠道移植后的神经问题可能呈现广泛的临床谱,主要是轻度至重度的中枢神经系统疾病。认识到这些并发症对患者的生存至关重要,因为这将有助于临床医生进行预防、及时诊断和治疗。本综述探讨了最常见的神经疾病,并提出了管理要点,有助于肠道移植受者的日常临床护理。