NEUROTOXICITY AFTER ORTHOTOPIC LIVER-TRANSPLANTATION - A COMPARISON BETWEEN CYCLOSPORINE AND FK506

Neurotoxicity represents a serious complication following orthotopic l iver transplantation. Neurotoxicity may be evoked by various periopera tive factors or develop due to drug-specific toxicity of immunosuppres sion. We evaluated the incidence of neurotoxicity in 121 patients, 61 randomly assigned to FK506 and 60 to CsA-based immunosuppression. The incidence of moderate or severe neurotoxicity was markedly higher in p atients treated with FK506 in the early postoperative period (21.3% vs . 11.7% in patients receiving CsA), after retransplantation (100% vs. O% in patients receiving CsA), and late (8 of 10 patients; P less than or equal to 0.05 vs. CsA). Furthermore late neurotoxicity was highly associated with severe infections and MOFS, which had a lethal outcome in more than 50% of the patients. Patients who subsequently died deve loped neurologic symptoms in 67% of the cases. These patients also exp erienced moderate or severe neurotoxicity significantly more often in the early postoperative period compared with patients with a successfu l outcome (50% vs. 17.3%; P less than or equal to 0.01). However, vari ous blood and serum parameters, including ALT, bilirubin, urea, creati nine and glucose, when analyzed alone or in multivariate fashion, also correlated significantly with the incidence and severity of early pos toperative neurotoxicity, indicating that neurotoxicity following LTX may be caused by various factors and is not exclusively a drug specifi c side effect of immunosuppression.