1. Neurological complications after liver transplantation as a consequence of immunosuppression: univariate and multivariate analysis of risk factors.
- Author
-
Rompianesi G, Montalti R, Cautero N, De Ruvo N, Stafford A, Bronzoni C, Ballarin R, De Pietri L, Di Benedetto F, and Gerunda GE
- Subjects
- Adult, Aged, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Incidence, Logistic Models, Male, Middle Aged, Multivariate Analysis, Nervous System Diseases epidemiology, Nervous System Diseases etiology, Outcome Assessment, Health Care, Postoperative Complications epidemiology, Prevalence, Retrospective Studies, Risk Factors, Calcineurin Inhibitors adverse effects, Everolimus adverse effects, Immunosuppression Therapy adverse effects, Immunosuppressive Agents adverse effects, Liver Transplantation, Nervous System Diseases immunology, Postoperative Complications immunology
- Abstract
Neurological complications (NCs) can frequently and significantly affect morbidity and mortality of liver transplant (LT) recipients. We analysed incidence, risk factors, outcome and impact of the immunosuppressive therapy on NC development after LT. We analysed 478 LT in 440 patients, and 93 (19.5%) were followed by NCs. The average LOS was longer in patients experiencing NCs. The 1-, 3- and 5-year graft survival and patient survival were similar in patients with or without a NC. Multivariate analysis showed the following as independent risk factors for NC: a MELD score ≥20 (OR = 1.934, CI = 1.186-3.153) and an immunosuppressive regimen based on calcineurin inhibitors (CNIs) (OR = 1.669, CI = 1.009-2.760). Among patients receiving an everolimus-based immunosuppression, the 7.1% developed NCs, vs. the 16.9% in those receiving a CNI (P = 0.039). There was a 1-, 3- and 5-year NC-free survival of 81.7%, 81.1% and 77.7% in patients receiving a CNI-based regimen and 95.1%, 93.6% and 92.7% in those not receiving a CNI-based regimen (P < 0.001). In patients undergoing a LT and presenting with nonmodifiable risk factors for developing NCs, an immunosuppressive regimen based on CNIs is likely to result in a higher rate of NCs compared to mTOR inhibitors., (© 2015 Steunstichting ESOT.)
- Published
- 2015
- Full Text
- View/download PDF