Burkhalter E L, Starzl T E, Van Thiel D H
Pittsburgh Transplantation Institute, University of Pittsburgh Medical Center, PA.
J Hepatol. 1994 Oct;21(4):572-7. doi: 10.1016/s0168-8278(94)80103-7.
The objective of this study was to define the severe neurological complications that occur in recipients of an orthotopic liver transplantation, receiving FK 506 as their primary immunosuppressive agent. To accomplish this, 100 consecutive orthotopic liver transplantation patients were followed prospectively from the time of their transplant until the date of their initial post-orthotopic liver transplantation discharge from hospital. All major neurological complications occurring during this period were recorded and assessed. The frequency of severe neurological complications occurring in these severely ill transplant recipients was 34%. Delirium was noted in 16, coma in 9, seizures in 4, and 5 developed focal motor deficits associated with the finding of a brain abscess, transient ischemic attack or central pontine myelinolysis. At the time at which a major neurologic complication was noted, the blood level of FK 506 was recorded. No direct relationship between FK 506 blood levels and the presence or absence of major neurologic complications of orthotopic liver transplantation could be demonstrated. Based upon this series, it can be concluded that although FK 506 may contribute to the pathogenesis of minor neurological complications seen after orthotopic liver transplantation such as tremors and headaches, the pathogenesis of most of the major neurologic complications occurring after orthotopic liver transplantation is multifactorial and cannot be ascribed solely to FK 506 toxicity.
本研究的目的是明确原位肝移植受者中发生的严重神经并发症，这些受者以FK 506作为主要免疫抑制剂。为实现这一目标，对100例连续的原位肝移植患者进行前瞻性随访，从移植时起直至原位肝移植术后首次出院日期。记录并评估在此期间发生的所有主要神经并发症。这些重症移植受者中严重神经并发症的发生率为34%。16例出现谵妄，9例昏迷，4例癫痫发作，5例出现与脑脓肿、短暂性脑缺血发作或中枢性桥脑髓鞘溶解相关的局灶性运动功能缺损。在发现主要神经并发症时，记录FK 506的血药浓度。未发现FK 506血药浓度与原位肝移植主要神经并发症的发生与否之间存在直接关系。基于本系列研究，可以得出结论，尽管FK 506可能促成原位肝移植后出现的轻微神经并发症（如震颤和头痛）的发病机制，但原位肝移植后发生的大多数主要神经并发症的发病机制是多因素的，不能仅归因于FK 506毒性。
