Chiara Crivellin1, Annachiara Cagnin, Renzo Manara, Patrizia Boccagni, Umberto Cillo, Paolo Feltracco, Stefania Barbieri, Alberto Ferrarese, Giacomo Germani, Francesco Paolo Russo, Patrizia Burra, Marco Senzolo. 1. 1 Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy. 2 Department of Neurosciences, Sciences NPSRR, University Hospital of Padua, Padua, Italy. 3 IRCCS San Camillo Foundation, Venice, Italy. 4 Department of Neuroradiology, University of Salerno, Salerno, Italy. 5 Hepatobiliary Surgery and Liver Transplant Center, University Hospital of Padua, Padua Italy. 6 Operative Unit of Anesthesia and Intensive Care, Department of Medicine, University Hospital of Padua, Padua, Italy.
Abstract
BACKGROUND: Central pontine and extrapontine myelinolysis (CPM/EPM) are severe neurologic complications after liver transplantation. METHODS: The present work retrospectively evaluated single-center prevalence of CPM/EPM and associated risk factors: cause of liver disease, hepatic encephalopathy, preoperative, intraoperative, and perioperative blood components use, serum levels, and variation of Na, Cl, and K and immunosuppression were compared between CPM/EPM patients and control group of transplanted patients without neurologic complications. RESULTS: Among 997 transplants, CPM/EPM were diagnosed in 11 patients (1.1%), of whom four were CPM, one was EPM, and six were associated CPM and EPM. Control group consisted of 44 transplanted patients. Central pontine and extrapontine myelinolysis patients experienced higher intraoperative and perioperative serum Na/24 hr variations compared to controls (16.69 ± 5.17 vs. 9.8 ± 3.4 mEq/L, P = 0.001). Maximum peak of intraoperative or perioperative serum Na was significantly higher in patients compared to controls (151.5 ± 3.3 vs. 140.8 ± 6.2 mEq/L, P ≤ 0.001), but no difference in preoperative serum Na was detected. Three patients presented hypernatremia as isolated risk factor. CONCLUSION: Extrapontine myelinolysis can be found isolated or associated with CPM in up to two of three liver transplanted patients with myelinolysis. A marked variation of perioperative serum Na remains the main risk factor even in patients without preexisting hyponatremia; however, isolated hypernatremia may be solely responsible in some cases.
BACKGROUND: Central pontine and extrapontine myelinolysis (CPM/EPM) are severe neurologic complications after liver transplantation. METHODS: The present work retrospectively evaluated single-center prevalence of CPM/EPM and associated risk factors: cause of liver disease, hepatic encephalopathy, preoperative, intraoperative, and perioperative blood components use, serum levels, and variation of Na, Cl, and K and immunosuppression were compared between CPM/EPM patients and control group of transplanted patients without neurologic complications. RESULTS: Among 997 transplants, CPM/EPM were diagnosed in 11 patients (1.1%), of whom four were CPM, one was EPM, and six were associated CPM and EPM. Control group consisted of 44 transplanted patients. Central pontine and extrapontine myelinolysispatients experienced higher intraoperative and perioperative serum Na/24 hr variations compared to controls (16.69 ± 5.17 vs. 9.8 ± 3.4 mEq/L, P = 0.001). Maximum peak of intraoperative or perioperative serum Na was significantly higher in patients compared to controls (151.5 ± 3.3 vs. 140.8 ± 6.2 mEq/L, P ≤ 0.001), but no difference in preoperative serum Na was detected. Three patients presented hypernatremia as isolated risk factor. CONCLUSION: Extrapontine myelinolysis can be found isolated or associated with CPM in up to two of three liver transplanted patients with myelinolysis. A marked variation of perioperative serum Na remains the main risk factor even in patients without preexisting hyponatremia; however, isolated hypernatremia may be solely responsible in some cases.
Authors: Karin Gmitterová; Michal Minár; Miroslav Žigrai; Zuzana Košutzká; Alice Kušnírová; Peter Valkovič Journal: BMC Neurol Date: 2018-04-20 Impact factor: 2.474