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Early post‐transplant hyperbilirubinemia is a possible predictive factor for developing neurological complications in pediatric living donor liver transplant patients receiving tacrolimus
Author(s) -
Sato Kazushige,
Kobayashi Yoshinobu,
Nakamura Atsushi,
Fukushima Daizo,
Satomi Susumu
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12843
Subject(s) - medicine , tacrolimus , stupor , liver transplantation , univariate analysis , pediatrics , surgery , transplantation , multivariate analysis , gastroenterology , vomiting
The cause of post‐transplant CNI ‐ NC s is multifactorial and not ascribed solely to CNI toxicity. A total of 90 children (aged <20 years) who underwent LDLT were evaluated to investigate the predictive factors associated with CNI ‐ NC s. Twelve patients (13.3%) developed CNI ‐ NC s after LDLT (age range, 2‐15 years). The symptoms of CNI ‐ NC s were seizures, VD, and stupor. The median onset of CNI ‐ NC s was 10 days (range, 5‐30 days) post‐transplant. In the univariate analysis, higher recipient age at LDLT , donor age and recipient's BW, lower actual GV/SLV and TAC dosage/BW, and higher mean T‐Bil and sodium level for 7 days after transplantation were independently significantly associated with TAC ‐ NC s. Multivariate analysis showed that the T‐Bil level in the first week after LDLT was the only significant independent predictive factor for TAC ‐ NC s ( HR , 1.588; 95% CI, 1.042‐2.358; P =.031). In conclusion, CNI ‐ NC s occurred most frequently in children over 5 years and were associated with hyperbilirubinemia for 7 days post‐transplant, regardless of TAC levels. The transplant team should refer to a neurologist to define the diagnosis and to collaborate to resolve the neurological problems.