CENTRAL-NERVOUS-SYSTEM TOXICITY AFTER LIVER-TRANSPLANTATION - THE ROLE OF CYCLOSPORINE AND CHOLESTEROL
CENTRAL-NERVOUS-SYSTEM TOXICITY AFTER LIVER-TRANSPLANTATION - THE ROLE OF CYCLOSPORINE AND CHOLESTEROL
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DOI：
10.1056/nejm198710013171404
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发表时间：
1987-10-01
影响因子：
158.5
通讯作者：
KROM, RAF
中科院分区：
文献类型：
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作者：
DEGROEN, PC;AKSAMIT, AJ;KROM, RAF
我们描述了三名接受肝移植的患者与环孢素治疗相关的严重中枢神经系统（CNS）毒性，表现为精神错乱、皮质盲、四肢瘫痪、癫痫发作和昏迷。 CT 和磁共振研究显示白质存在严重的弥漫性病变。所有副作用和放射学结果均随着环孢素的停药或剂量减少而逆转。我们还观察到移植后中枢神经系统副作用与总血清胆固醇水平之间呈负相关。对 48 名患者进行的 54 例肝移植的回顾性分析显示，13 名患者出现与使用环孢菌素相关的中枢神经系统毒性症状。与无症状患者相比，这些患者在移植后第一周的血清总胆固醇水平降低（平均值±SE，94±4 mg/dL vs. 132±6，或2.44±0.10 mmol/L vs. 3.43+0.16）。我们的结论是，在肝移植中使用环孢素治疗免疫抑制可能会引起脑病、癫痫发作和白质改变的综合征，并且这最有可能发生在移植后血清总胆固醇水平较低的患者中。 （新英格兰医学杂志 1987 年；317：861–6。）
We describe severe central nervous system (CNS) toxicity, manifested by confusion, cortical blindness, quadriplegia, seizures, and coma, associated with cyclosporine treatment in three patients undergoing liver transplantation. CT and magnetic resonance studies disclosed a severe, diffuse disorder of the white matter. All side effects and radiographic findings were reversed with discontinuation or a reduction in the dose of cyclosporine.We also observed an inverse association between CNS side effects and total serum cholesterol levels after transplantation. A retrospective analysis of 54 liver transplantations performed in 48 patients revealed that 13 patients had symptoms of CNS toxicity associated with the use of cyclosporine. These patients' total serum cholesterol levels in the first week after transplantation were reduced as compared with those in patients without symptoms (mean ±SE, 94±4 mg per deciliter vs. 132±6, or 2.44±0.10 mmol per liter vs. 3.43+0.16).We conclude that cyclosporine therapy for immunosuppression in liver transplantation may cause a syndrome of encephalopathy, seizures, and white-matter changes and that this is most likely to occur in patients with low total serum cholesterol levels after transplantation. (N Engl J Med 1987; 317:861–6.)