肾移植后长期使用他克莫司治疗的患者与肝移植后患者的脑功能和代谢比较。
Brain function and metabolism in patients with long-term tacrolimus therapy after kidney transplantation in comparison to patients after liver transplantation.
机构信息
Department of Neurology, Hannover Medical School, Hannover, Germany.
Integrated Research and Treatment Centre Transplantation, Hannover Medical School, Hannover, Germany.
出版信息
PLoS One. 2020 Mar 10;15(3):e0229759. doi: 10.1371/journal.pone.0229759. eCollection 2020.
BACKGROUND
About 50% of the patients 5-7 years after kidney transplantation show impairment of memory, attention and executive function. Tacrolimus frequently induces neurological complications in the first few weeks after transplantation. Furthermore, tacrolimus treatment is associated with impaired cognitive function in the long-term in patients after liver transplantation. We hypothesize that long-term tacrolimus therapy is associated with cognitive dysfunction and alterations of brain structure and metabolism in patients after kidney transplantation.
METHODS
Twenty-one patients 10 years after kidney transplantation underwent cognitive testing, magnetic resonance imaging and whole brain 31-phosphor magnetic resonance spectroscopy for the assessment of brain function, structure and energy metabolism. Using a cross-sectional study design the results were compared to those of patients 1 (n = 11) and 5 years (n = 10) after kidney transplantation, and healthy controls (n = 17). To further analyze the share of transplantation, tacrolimus therapy and kidney dysfunction on the results patients after liver transplantation (n = 9) were selected as a patient control group.
RESULTS
Patients 1 and 10 years after kidney transplantation (p = 0.02) similar to patients 10 years after liver transplantation (p<0.01) showed significantly worse cognitive function than healthy controls. In contrast to patients after liver transplantation patients after kidney transplantation showed significantly reduced adenosine triphosphate levels in the brain compared to healthy controls (p≤0.01). Patients 1 and 5 years after kidney transplantation had significantly increased periventricular hyperintensities compared to healthy controls (p<0.05).
CONCLUSIONS
Our data indicate that cognitive impairment in the long-term after liver and kidney transplantation cannot exclusively be explained by CNI neurotoxicity.
背景
约 50%的肾移植患者在移植后 5-7 年会出现记忆、注意力和执行功能受损。环孢素在移植后最初几周内经常引起神经并发症。此外，环孢素治疗与肝移植患者的长期认知功能受损有关。我们假设长期使用环孢素治疗与肾移植患者的认知功能障碍以及大脑结构和代谢改变有关。
方法
21 例肾移植后 10 年的患者接受了认知测试、磁共振成像和全脑 31 磷磁共振波谱检查，以评估大脑功能、结构和能量代谢。使用横断面研究设计，将结果与肾移植后 1 年（n=11）和 5 年（n=10）的患者以及健康对照组（n=17）进行比较。为了进一步分析移植、环孢素治疗和肾功能不全对结果的影响，选择了 9 例肝移植后患者作为患者对照组。
结果
肾移植后 1 年和 10 年的患者（p=0.02）与肝移植后 10 年的患者（p<0.01）相似，认知功能明显差于健康对照组。与肝移植后患者相比，肾移植后患者的脑内三磷酸腺苷水平明显降低（p≤0.01）。与健康对照组相比，肾移植后 1 年和 5 年的患者的脑室周围高信号明显增加（p<0.05）。
结论
我们的数据表明，肝移植和肾移植后长期的认知障碍不能完全用 CNI 神经毒性来解释。
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