CENTRAL PONTINE MYELINOLYSIS AND CYCLOSPORINE NEUROTOXICITY FOLLOWINGLIVER-TRANSPLANTATION

In a recent series of 44 liver transplants we identified both extrapon tine myelinolysis (EPM)-characteristic of cyclocosporine neurotoxicity -and central pontine myelinolysis (CPM) in 5 recipients posttransplant . An additional 2 recipients had EPM only posttransplant. MRIs perform ed in 4 asymptomatic recipients were normal. Large perioperative shift s in serum sodium, hypomagnesemia, and high cyclosporine levels may pl ay a role in the development of these lesions, although the evidence f rom this study is inconclusive, In addition to supportive care, dilant in was started in patients who had seizures; aggressive magnesium repl acement was initiated for hypomagnesemia, and cyclosporine levels were reduced in all patients. All patients demonstrated a slow steady reco very and all but 2 are home at the time of writing. CPM may be more pr evalent than previously appreciated following liver transplantation, a lthough its prognosis may not be as dismal.