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Bertorini TE, Finder JD, Bassam BA. Perioperative Management of Patients With Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lee YJ, Yum MS, Kim EH, Kim MJ, Kim KM, Im HJ, Kim YH, Park YS, Ko TS. Clinical Characteristics of Transplant-associated Encephalopathy in Children. J Korean Med Sci 2017; 32:457-464. [PMID: 28145649 PMCID: PMC5290105 DOI: 10.3346/jkms.2017.32.3.457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/30/2016] [Indexed: 12/27/2022] Open
Abstract
We aimed to analyze characteristics of encephalopathy after both hematopoietic stem cell and solid organ pediatric transplantation. We retrospectively reviewed medical records of 662 pediatric transplant recipients (201 with liver transplantation [LT], 55 with heart transplantation [HT], and 67 with kidney transplantation [KT], 339 with allogeneic hematopoietic stem cell transplantation [HSCT]) who received their graft organs at Asan Medical Center between January 2000 and July 2014. Of the 662 patients, 50 (7.6%) experienced encephalopathy after transplantation. The incidence of encephalopathy was significantly different according to the type of organ transplant: LT, 16/201 (8.0%), HT, 13/55 (23.6%), KT, 5/67 (7.5%), and HSCT, 16/339 (4.7%) (P < 0.001). Drug-induced encephalopathy (n = 14) was the most common encephalopathy for all transplant types, but particularly after HSCT. Hypertensive encephalopathy was the most common after KT and HT, whereas metabolic encephalopathy was the most common after LT. The median time to encephalopathy onset also differed according to the transplant type: 5 days after KT (range 0-491 days), 10 days after HT (1-296 days), 49.5 days after HSCT (9-1,405 days), and 39 days after LT (1-1,092 days) (P = 0.018). The mortality rate among patients with encephalopathy was 42.0% (n = 21/50). Only 5 patients died of neurologic complications. Transplant-associated encephalopathy presented different characteristics according to the type of transplant. Specialized diagnostic approach for neurologic complications specific to the type of transplant may improve survival and quality of life in children after transplantation.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
| | - Mi Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hee Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Min Jee Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hwue Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sung Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
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Ruzhansky KM, Brannagan TH. Neuromuscular complications of hematopoietic stem cell transplantation. Muscle Nerve 2015; 52:480-7. [DOI: 10.1002/mus.24724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Katherine M. Ruzhansky
- Medical University of South Carolina, Department of Neurology and Neurosurgery; Neuromuscular Division; 96 Jonathan Lucas Street, CSB 301 Charleston South Carolina 29425 USA
| | - Thomas H Brannagan
- Columbia University Medical Center, Peripheral Neuropathy Center; Neurological Institute; New York New York USA
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Jacewicz M, Marino CR. Neurologic complications of pancreas and small bowel transplantation. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1277-1293. [PMID: 24365419 DOI: 10.1016/b978-0-7020-4088-7.00087-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the past decade, substantial improvements in patient and graft survival for pancreas and small bowel transplants have been achieved. Despite this progress, many patients still develop neurologic complications in the course of their illness. Small bowel transplants produce more neurologic complications because of the complex metabolic environment in which the procedure is performed and because of the intense immune suppression necessitated by the greater immunogenicity of the intestinal mucosa. Pancreas transplants stabilize and/or improve the signs and symptoms of diabetic neuropathy over time. Because transplantation of the pancreas is often coupled with a kidney transplant and small intestine with liver, neurologic complications in these patients sometimes reflect problems involving the organ partner or both organs. The spectrum of neurologic complications for pancreas and small bowel transplant recipients is similar to other organ transplants but their frequency varies depending on the type of transplant performed.
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Affiliation(s)
- Michael Jacewicz
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Christopher R Marino
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Ce P, Koskderelioglu A, Coban G, Gedizlioglu M, Nart A, Uslu A. Neurologic Complications of Renal Transplant. EXP CLIN TRANSPLANT 2012; 10:243-6. [DOI: 10.6002/ect.2011.0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zaubler T, Fann JR, Roth-Roemer S, Katon WJ, Bustami R, Syrjala KL. Impact of delirium on decision-making capacity after hematopoietic stem-cell transplantation. PSYCHOSOMATICS 2010; 51:320-9. [PMID: 20587760 DOI: 10.1176/appi.psy.51.4.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delirium is a common complication of myeloablative hematopoietic stem-cell transplantation (HSCT), yet no studies have explored the later effects of an episode of delirium in this setting on patients' decision-making capacity after the acute symptoms of delirium have resolved. OBJECTIVE The authors assessed the impact of delirium during the acute phase of myeloablative HSCT on later decision-making capacity. METHOD Decision-making capacity was assessed with the MacArthur Competence Assessment Tool in 19 patients before they received their first HSCT and at 30 and 80 days post-transplantation. Delirium was assessed 3 times per week with the Delirium Rating Scale and the Memorial Delirium Assessment Scale from 7 days pre-transplantation through 30 days post-transplantation. RESULTS Although there was little variance in the pre-treatment scores, with most patients showing very high or perfect scores on decision-making abilities, a multivariate regression model showed that delirium was predictive of a lower reasoning score at Day 30 post-transplantation. CONCLUSION Patients who experienced a delirium episode during the acute phase of HSCT were not likely to develop clinically meaningful impairments in decision-making capacity post-transplantation, although they evidenced minor impairment in their reasoning ability.
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Affiliation(s)
- Thomas Zaubler
- Morristown Memorial Hospital, 100 Madison Ave., Morristown, NJ 07962, USA.
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Zaubler T, Fann JR, Roth-Roemer S, Katon WJ, Bustami R, Syrjala KL. Impact of Delirium on Decision-Making Capacity After Hematopoietic Stem-Cell Transplantation. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70703-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Neurologic complications affect posttransplant recovery of more than 20% of transplant recipients. Etiology is usually related to surgical procedure of transplantation, primary disorders causing failure of transplanted organ, opportunistic infections, and neurotoxicity of immunosuppressive medications. Risk of opportunistic infections and immunosuppressant neurotoxicity is greatest within the first six months, but it persists along with long-term maintenance immunosuppression required to prevent graft rejection. Neurotoxicity may require alteration of immunosuppressive regimen, and prompt therapy of opportunistic infections improves outcomes.
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Affiliation(s)
- Sasa A Zivković
- Neurology Service, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
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Abstract
BACKGROUND Neurologists are frequently called to evaluate patients in the intensive care units who are not waking up. This often poses a diagnostic and prognostic dilemma. REVIEW SUMMARY The initial evaluation starts with abstracting the prehospital and in-hospital history, followed by bedside clinical and neurologic examination to establish a differential diagnosis. The subsequent work-up is based on clinical suspicion where reversible life-threatening causes should be immediately identified. After confirming the diagnosis and implementation of the appropriate medical management, a prompt family meeting and counseling is recommended. The role of neurologists in clinical diagnosis and prognostication of the coma patient, as well as diagnosing brain death is instrumental. CONCLUSIONS In this review, we explore a practical systematic approach to patients with decreased level of consciousness. The most common causes of impaired alertness in different non-neurologic critical care units and commonly used prognostication tools are presented. Finally a brief introduction of hypothermia, a novel therapeutic approach is also discussed.
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Incidence and risk factors for seizures after heart transplantation. J Neurol 2009; 257:563-8. [PMID: 19894074 DOI: 10.1007/s00415-009-5366-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 10/12/2009] [Accepted: 10/19/2009] [Indexed: 02/02/2023]
Abstract
Neurological complications can occur after heart transplantation and present with seizures. We examined the incidence of seizures from a population of adult patients who had received heart transplants over a period of 3 years. Brain MRI and clinical data were analysed to identify the risk factors for the seizures. Eight of the 166 post-transplant patients presented seizures (4.8%). The first seizures occurred with a mean of 30 days after the transplantation. For seven patients, the mean delay was 8 days, and for one, it was longer, 172 days. The analysis of brain MRI showed two main epileptogenic factors in the early post-transplant seizures: posterior reversible encephalopathy syndrome (PRES) due to cyclosporine treatment (n = 4) and cortical ischemic stroke (n = 5). In two patients, we identified multiple epileptogenic factors, including notably the association of PRES and cortical stroke. Since treatment of seizures in patients in the intensive care unit (ICU) after heart transplantation depends on identifying and correcting the causes, FLAIR and diffusion MRI sequences are needed, even if the patients have a previous history of epilepsy. Seizures were easy to control. In patients with PRES, imaging and clinical abnormalities improved when cyclosporine was replaced by another immunosuppressive treatment. Death of three patients was not related to seizures, but to infectious or malignant complications of immunosuppressive treatments (n = 2) or to post-stroke neurological deficit (n = 1). Mortality was similar among patients presenting seizures and those who did not.
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Živković SA, Eidelman BH, Bond G, Costa G, Abu-Elmagd KM. The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation. Clin Transplant 2009; 24:164-8. [DOI: 10.1111/j.1399-0012.2009.01065.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zivković SA, Jumaa M, Barisić N, McCurry K. Neurologic complications following lung transplantation. J Neurol Sci 2009; 280:90-3. [PMID: 19249798 DOI: 10.1016/j.jns.2009.02.308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/14/2009] [Accepted: 02/09/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurologic complications are frequent after solid organ transplantation, but their spectrum in lung transplant recipients has not been characterized. METHODS Retrospective analysis of medical records of 132 consecutive adult lung allograft recipients transplanted at the University of Pittsburgh Medical Center between 2001 and 2003 with a follow-up until December 31, 2005. RESULT Neurologic complications were reported in 68% of lung transplant recipients. Most common complications were impairment of consciousness (25%), neuromuscular complications (21%) and headaches (20%). The presence of neurologic complications did not affect posttransplant survival. Neurologic complications were commonly related to immunosuppressant neurotoxicity (17%) and opportunistic infections (11%). There was a trend for an increased frequency of seizures and headaches in recipients with cystic fibrosis (p>0.05). CONCLUSIONS Neurologic complications are a significant source of morbidity in lung transplant recipients. High prevalence of immunosuppressant toxicity is attributable to higher immunosuppression needs for effective prevention of allograft rejection. Frequent opportunistic infections are associated with complications related to systemic and CNS infections and toxicity of antibiotics. Patients with cystic fibrosis may be at higher risk of neurologic complications, but larger studies are needed to corroborate this finding and fully characterize the spectrum of neurologic complications following lung transplantation.
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Drent G, Moons P, De Geest S, Kleibeuker JH, Haagsma EB. Symptom experience associated with immunosuppressive drugs after liver transplantation in adults: possible relationship with medication non-compliance? Clin Transplant 2008; 22:700-9. [PMID: 18673378 DOI: 10.1111/j.1399-0012.2008.00864.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Symptom experience (occurrence and perceived distress) associated with side effects of immunosuppressive medications in organ transplant patients may well be associated with poorer quality of life and medication non-compliance. The aims of this study were: first, to assess symptom experience in clinically stable adult patients during long-term follow-up after liver transplantation; and second, to study the relationship between symptom experience and medication non-compliance. This cross-sectional study included 123 liver transplant patients. Symptom experience was assessed using the "Modified Transplant Symptom Occurrence and Symptom Distress Scale" (29-item version) at the annual evaluation. According to the duration of follow-up, patients were divided into a short-term (1-4 yr) and a long-term (5-18 yr) cohort. Medication non-compliance was measured using electronic monitoring. Results showed that increased hair growth was the most frequent symptom in both sexes. Symptom distress was more serious in women than in men. The most distressing symptom in women was excessive and/or painful periods, while in men this was impotence. Clear differences were revealed at item level between symptom occurrence and symptom distress in relationship with the two time cohorts and between sexes. No relationship was found between symptom experience and prednisolone non-compliance.
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Affiliation(s)
- G Drent
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Amodio P, Biancardi A, Montagnese S, Angeli P, Iannizzi P, Cillo U, D'Amico D, Gatta A. Neurological complications after orthotopic liver transplantation. Dig Liver Dis 2007; 39:740-7. [PMID: 17611177 DOI: 10.1016/j.dld.2007.05.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 05/08/2007] [Accepted: 05/08/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND The number of orthotopic liver transplantation performed each year is increasing due to increased safety and logistic facilities. Therefore, the importance of reducing adverse events is progressively growing. AIM To review present knowledge on the neurological complications of orthotopic liver transplantation. METHODS The epidemiology, the clinical features and the pathophysiology of the neurological complications of orthotopic liver transplants, resulting from a systematic review of the literature in the last 25 years, are summarized. RESULTS AND CONCLUSIONS The review highlights that a relevant variety of neurological adverse events can occur in patients undergoing orthotopic liver transplantation. The knowledge of neurological complications of orthotopic liver transplantation is important for transplantation teams to reduce their prevalence and improve their management. In addition, the likelihood of neurological adverse effects provides evidence for the need of a careful cognitive and neurological work up of patients in the orthotopic liver transplantation waiting list, in order to recognize and interpret neurological dysfunction occurring after orthotopic liver transplantation.
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Affiliation(s)
- P Amodio
- Clinical Medicine 5 and Veneto Regional Reference Centre for Hepatic Diseases, University of Padova, Padova, Italy.
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Abstract
Neurologic complications are common after transplantation and affect 30-60% of transplant recipients. The etiology of most of the posttransplant neurologic disorders is related to the opportunistic infections, both systemic and involving central nervous system (CNS), toxicity of immunosuppressive medications, and the metabolic insult created by the underlying primary disease and the transplant procedure. Neuroimaging studies are one of the key tools in the evaluation and enable early diagnosis of neurologic complications in transplant patients, especially posterior reversible leukoencephalopathy syndrome, central pontine myelinolysis, intracerebral hemorrhage, and fungal and bacterial abscesses. Magnetic resonance imaging (MRI) is the preferred technique, but each of the available neuroimaging techniques offers a unique insight into the pathophysiologic mechanisms underlying neurologic complications of transplantation. The role of neuroimaging in this population includes early detection of calcineurin inhibitor neurotoxicity, opportunistic infections, neoplasia, metabolic disorders, or cerebrovascular diseases. In addition, we can monitor longitudinal progression of disease and treatment response.
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Affiliation(s)
- Sasa Zivković
- VA Pittsburgh HCS and Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Atamaz F, Hepgüler S, Karasu Z, Kilic M. Meralgia paresthetica after liver transplantation: a case report. Transplant Proc 2006; 37:4424-5. [PMID: 16387136 DOI: 10.1016/j.transproceed.2005.11.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The focal neuropathies after orthotropic liver transplantation (OLTx) have been well documented to date. Most injuries to the peripheral nervous system involve the peroneal nerve and brachial plexus. We report the first case of lateral femoral cutaneous nerve (LFCN) injury after OLTx. The patient presented with pain and numbness on the lateral aspect of the right thigh that had progressively worsened since operation. Electrodiagnostic studies were indicative for right meralgia paresthetica (MP). The symptoms of MP improved progressively after physical therapy applications during the first 3 months. The etiology of MP in this case is unclear. However, it may be considered that ascites, surgical mechanisms, and immunosuppressive therapy were possible causative factors.
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Affiliation(s)
- F Atamaz
- Department of Physical Therapy and Rehabilitation, Ege University Medical School, Izmir, Turkey.
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Mendez O, Kanal E, Abu-Elmagd KM, McFadden K, Thomas S, Bond G, Zivković SA. Granulomatous amebic encephalitis in a multivisceral transplant recipient. Eur J Neurol 2006; 13:292-5. [PMID: 16618348 DOI: 10.1111/j.1468-1331.2006.01168.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 40-year-old man with multivisceral allograft developed acutely right-sided numbness 9 months after transplantation. Cranial magnetic resonance imaging (MRI) showed a small left parietal lesion, and cerebrospinal fluid analysis was unremarkable. Stereotactic brain biopsy was non-diagnostic. The patient continued to deteriorate, developed cerebral edema and died at 13 days after the onset of symptoms. Unexpectedly, autopsy demonstrated acanthamebic encephalitis. This case highlights diagnostic difficulties encountered with amebic encephalitis and expands the spectrum of opportunistic central nervous system (CNS) infections in solid and visceral organ transplant recipients.
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Affiliation(s)
- O Mendez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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