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Wijdicks EF, Hocker SE. Neurologic complications of liver transplantation. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1257-66. [DOI: 10.1016/b978-0-7020-4088-7.00085-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Dimachkie MM, Barohn RJ. Chronic inflammatory demyelinating polyneuropathy. Curr Treat Options Neurol 2013; 15:350-66. [PMID: 23564314 DOI: 10.1007/s11940-013-0229-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Chronic Inflammatory polyneuropathies are an important group of neuromuscular disorders that present chronically and progress over more than 8 weeks, being referred to as chronic inflammatory demyelinating polyneuropathy (CIDP). Despite tremendous progress in elucidating disease pathogenesis, the exact triggering event remains unknown. Our knowledge regarding diagnosis and management of CIDP and its variants continues to expand, resulting in improved opportunities for identification and treatment. Most clinical neurologists will be involved in the management of patients with these disorders, and should be familiar with available therapies for CIDP. We review the distinctive clinical, laboratory, and electro-diagnostic features that aid in diagnosis. We emphasize the importance of clinical patterns that define treatment responsiveness and the most appropriate therapies in order to improve prognosis.
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Affiliation(s)
- Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd., Mail Stop 2012, Kansas City, KS, 66160, USA,
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Stübgen JP. Drug-induced dysimmune demyelinating neuropathies. J Neurol Sci 2011; 307:1-8. [DOI: 10.1016/j.jns.2011.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/05/2011] [Accepted: 05/11/2011] [Indexed: 12/30/2022]
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Bilodeau M, Hassoun Z, Brunet D. Demyelinating Sensorimotor Polyneuropathy Associated With the Use of Sirolimus: A Case Report. Transplant Proc 2008; 40:1545-7. [DOI: 10.1016/j.transproceed.2008.03.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 03/11/2008] [Indexed: 10/21/2022]
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Abstract
Neuromuscular complications in transplant recipients are common and contribute to morbidity and mortality. Complications such as acute and chronic inflammatory demyelinating polyneuropathies and toxic myopathies are related to the changes in immune modulation that occur after transplantation or result from immunosuppressive treatment toxicity. Alternatively, other complications such as myositis, myasthenia gravis, and mononeuropathy multiplex may result from a dysimmune systemic disorder such as post-transplant lymphoproliferative disorder, graft-versus-host disease or hepatitis C virus or hepatitis B virus chronic infection. Lastly, some of these complications, e.g., compression or stretch of individual nerves or plexus, are commonly seen in a postoperative setting and are not specific of patients with organ transplantation. This review focuses on the characteristic features, management, prognosis and pathophysiology of common and immune-related neuromuscular complications in organ transplant recipients.
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Moon JS, Souayah N. Guillain-Barré syndrome triggered by influenza vaccination in a recipient of liver transplant on FK506. Liver Transpl 2006; 12:1537-9. [PMID: 17004261 DOI: 10.1002/lt.20864] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Guillain-Barré syndrome (GBS) has been rarely reported after liver transplantation and generally has good outcome. We report a liver transplant patient on FK506 (tacrolimus) who developed GBS 6 months after liver transplantation. There was no evidence of liver rejection or active infection. Despite treatment with intravenous immunoglobulin, the patient expired. GBS occurred despite downregulation of T cells by FK506, suggesting that humoral dysfunction might be the predominant mechanism of GBS in this report.
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Affiliation(s)
- Joon-Shik Moon
- Department of Neurology, UMDNJ-New Jersey Medical School, Newark, NJ 07101, USA
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Guarino M, Benito-Leon J, Decruyenaere J, Schmutzhard E, Weissenborn K, Stracciari A. EFNS guidelines on management of neurological problems in liver transplantation. Eur J Neurol 2006; 13:2-9. [PMID: 16420387 DOI: 10.1111/j.1468-1331.2006.01353.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neurological impairment after orthotopic liver transplantation (OLT) is common and represents a major source of morbidity and mortality. The diagnosis and management of neurological problems occurring after OLT are difficult and evidence-based guidelines for this task are currently lacking. A Task Force was set up under the auspices of the European Federation of Neurological Societies to devise guidelines to prevent and manage neurological problems in OLT. We selected six major neurological problems and approached them combining an evidence-based scientific literature analysis with a search of consensus by means of a Delphi process. Search results were translated into a series of recommendations constituting a basis for better care of patients with neurological complications after OLT.
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Affiliation(s)
- M Guarino
- Neurology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Echaniz-Laguna A, Anheim M, Wolf P, Kessler R, Massard G, Mohr M, Moulin B, Braun-Parvez L, Jaeck D, Tranchant C. Polyradiculonévrite chronique chez des patients avec une greffe d’organe solide : une étude clinique, neurophysiologique et neuropathologique de 4 cas. Rev Neurol (Paris) 2005; 161:1213-20. [PMID: 16340917 DOI: 10.1016/s0035-3787(05)85195-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) rarely develops in patients with solid organ transplantation. PATIENTS AND METHOD We describe the clinical, biological, electrophysiological and neuropathological features of 4 patients with solid organ transplantation who developed CIDP. Two patients had liver transplantation, one had kidney transplantation and one had lung transplantation. RESULTS All 4 patients developed in the months following transplantation a syndrome that fulfilled criteria for definite CIDP. All patients had immunosuppressive therapy, with ciclosporin + prednisolone in 2 cases, tacrolimus in 1 case and azathioprine + prednisolone + ciclosporin in one case. One patient had chronic HCV and HBV infection. Treatment with intravenous immune globulin (IVIG) and/or a change in immunosuppressive therapy improved the neuropathy in all cases. CONCLUSION CIDP is a rare and potentially treatable condition that should be considered in all patients with solid organ transplantation who develop a rapidly disabling sensorimotor polyneuropathy.
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Marchiori PE, Lino AM, Britto N, Bacchella T, Machado MC, Mies S, Massarollo P, Scaff M. Neuropsychiatric complications due to organ transplantation: a survey of 1499 Brazilian patients at a single center in São Paulo, Brazil. Transplant Rev (Orlando) 2005. [DOI: 10.1016/j.trre.2005.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Echaniz-Laguna A, Battaglia F, Ellero B, Mohr M, Jaeck D. Chronic inflammatory demyelinating polyradiculoneuropathy in patients with liver transplantation. Muscle Nerve 2004; 30:501-4. [PMID: 15372442 DOI: 10.1002/mus.20086] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report two patients with orthotopic liver transplantation (OLT) who developed a syndrome that fulfilled criteria for definite chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). One patient had OLT because of alcoholic cirrhosis and one following hepatitis C-induced hepatic failure. Both had immunosuppressive therapy, with cyclosporine and prednisolone in one case and tacrolimus in the other case. Treatment with intravenous immune globulin (IVIG) significantly improved the neuropathy in both patients. In patients with OLT developing disabling sensorimotor neuropathies, CIDP should be considered as should the use of potentially beneficial immunosuppressive treatment.
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Affiliation(s)
- Andoni Echaniz-Laguna
- Département de Neurologie, Hôpital Civil de Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, France.
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Abstract
One of the most common uses of therapeutic plasmapheresis is for the treatment of immunologically mediated polyneuropathies. This paper discusses the use of plasmapheresis in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, polyneuropathies associated with paraproteins, lower motor neuron syndromes, and polyneuropathies associated with HIV. As the pathogenesis of immunologically mediated polyneuropathies becomes better understood, newer therapies for these syndromes will evolve: however, therapeutic plasmapheresis is likely to continue to play a central role in the treatment of many of these diseases.
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Affiliation(s)
- Dobri D Kiprov
- Division of Immunotherapy, California Pacific Medical Center and the Bay Area Mobile Apheresis Program, San Francisco, California, USA.
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Abstract
BACKGROUND Organ transplantation is one of the most dynamic fields in medicine and has evolved into a life-saving option for thousands of patients with previously fatal conditions. The posttransplantation clinical course is frequently associated with neurologic complications that are usually related to pretransplant morbidity, the surgical procedure of transplantation, immunosuppression, and opportunistic infection. REVIEW SUMMARY Neurologic complications of organ transplantation may be divided into complications common to all types of allografts and complications that are specific for a particular type of organ transplantation. The most common complications include seizures, opportunistic central nervous system (CNS) infection, metabolic encephalopathy, stroke, intracranial hemorrhage, and drug-related adverse events. Opportunistic CNS infection may have a subtle presentation and should not be overlooked, as the consequences of delayed treatment may be grave. Neurotoxicity of immunosuppressive agents is also a frequent cause of neurologic complications and may occur in the setting of normal serum drug levels. The clinical course of transplant patients is frequently complex, requiring close cooperation between the transplant team and specialty consultants. Prolonged survival of transplant patients will shift the focus of neurologic complications from acute, perioperative to chronic complications of immunosuppression. CONCLUSIONS Neurologic complications of organ transplantation are commonly related to opportunistic infection or neurotoxicity of immunosuppressive agents, requiring careful titration of immunosuppression. Timely diagnosis of CNS infection or other causes of neurologic dysfunction may significantly improve recovery and outcome in these patients.
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Affiliation(s)
- Misha Pless
- Eye and Ear Institute, and the Department of Neurology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA.
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Solaro C, Murialdo A, Giunti D, Mancardi G, Uccelli A. Central and peripheral nervous system complications following allogeneic bone marrow transplantation. Eur J Neurol 2001; 8:77-80. [PMID: 11509085 DOI: 10.1046/j.1468-1331.2001.00160.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although graft vs. host disease (GvHD) is a frequent complication of allogeneic bone marrow transplantation (BMT), involvement of the central and peripheral nervous systems (CNS and PNS, respectively) has not been demonstrated conclusively. Here, we report of a patient who, following allogeneic BMT for lymphoblastic T-cell lymphoma, suffered a syndrome characterized by self-remitting cerebellar and pyramidal signs associated with a progressive involvement of the peripheral nervous system (PNS). Clinical course and laboratory findings correlated with relapses of systemic GvDH, thus suggesting the possibility that involvement of CNS and PNS may be sustained by a similar pathogenic mechanism.
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Affiliation(s)
- C Solaro
- Department of Neurological Sciences and Vision, University of Genoa, Italy.
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Abstract
A number of presentations of chronic demyelinating polyneuropathy have been identified, each distinguished by its phenotypic pattern. In addition to classic chronic inflammatory demyelinating polyneuropathy (CIDP), which is characterized clinically by symmetric proximal and distal weakness and sensory loss, several regional variants can be recognized: multifocal motor neuropathy (MMN: asymmetric and pure motor), multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy (asymmetric, sensory, and motor), and distal acquired demyelinating symmetric (DADS) neuropathy (symmetric, distal, sensory, and motor). There are also temporal, pathological, and disease-associated variants. This review describes a clinical scheme for approaching the chronic acquired demyelinating polyneuropathies that leads to a rational use of supportive laboratory studies and treatment options. In addition, we propose new diagnostic criteria for CIDP that more accurately reflect current clinical practice.
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Affiliation(s)
- D S Saperstein
- Department of Neurology, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1 (MMCN), San Antonio, Texas 78236-5300, USA.
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Iani C, Tisone G, Loberti M, Orlando G, Negrini S, Strati F, Bernardi G, Casciani CU. Clinical and neurophysiological evidence of polyneuropathy in liver transplant candidates: preliminary report. Transplant Proc 1999; 31:404-5. [PMID: 10083162 DOI: 10.1016/s0041-1345(98)01680-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Iani
- Department of Neurology, Tor Vergata University, Rome, Italy
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