Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Am J Kidney Dis. 2019 Sep;74(3):390-398. doi: 10.1053/j.ajkd.2019.03.419. Epub 2019 Apr 27.
Neurologic complications are common after solid-organ transplantation, occurring in one-third of patients. Immunosuppression-related neurotoxicity (involving calcineurin inhibitors and corticosteroids), opportunistic central nervous system infections, seizures, and delirium are some of the causes of neurologic symptoms following solid-organ transplantation. An uncommon often missed complication posttransplantation involves buildup of ammonia levels that can lead to rapid clinical deterioration even when treated. Ammonia levels are not routinely checked due to the myriad of other explanations for encephalopathy in a transplant recipient. A treatment of choice for severe hyperammonemia involves renal replacement therapy (RRT), but there are no guidelines on the mode or parameters of RRT for reducing ammonia levels. Hyperammonemia in a transplant recipient poses specific challenges beyond the actual condition because the treatment (RRT) involves significant hemodynamic fluctuations that may affect the graft. In this review, we describe a patient with posttransplantation hyperammonemia and discuss the pathways of ammonia metabolism, potential factors underlying the development of hyperammonemia posttransplantation, and choice of appropriate therapeutic options in these patients.
神经并发症在实体器官移植后很常见，发生率为三分之一。免疫抑制相关的神经毒性（涉及钙调神经磷酸酶抑制剂和皮质类固醇）、机会性中枢神经系统感染、癫痫发作和谵妄是实体器官移植后出现神经症状的一些原因。移植后一种不常见但常被忽视的并发症涉及氨水平的积聚，即使经过治疗，也会导致迅速的临床恶化。由于移植受者脑病有多种其他解释，因此通常不检查氨水平。治疗严重高氨血症的首选方法是肾脏替代疗法（RRT），但对于降低氨水平的 RRT 模式或参数尚无指南。移植受者的高氨血症除了实际病情之外还带来了特定的挑战，因为治疗（RRT）会导致明显的血流动力学波动，可能会影响移植物。在这篇综述中，我们描述了一名移植后高氨血症患者，并讨论了氨代谢的途径、移植后高氨血症发展的潜在因素以及这些患者的适当治疗选择。
