Open AccessNeurological complications after liver transplantation as a consequence of immunosuppression: univariate and multivariate analysis of risk factors
Author(s) -
Rompianesi Gianluca,
Montalti Roberto,
Cautero Nicola,
De Ruvo Nicola,
Stafford Anthony,
Bronzoni Carolina,
Ballarin Roberto,
De Pietri Lesley,
Di Benedetto Fabrizio,
Gerunda Giorgio E.
Publication year - 2015
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12564
Subject(s) - medicine , immunosuppression , regimen , calcineurin , everolimus , liver transplantation , multivariate analysis , univariate analysis , incidence (geometry) , transplantation , gastroenterology , surgery , physics , optics
Summary Neurological complications ( NC s) can frequently and significantly affect morbidity and mortality of liver transplant ( LT ) recipients. We analysed incidence, risk factors, outcome and impact of the immunosuppressive therapy on NC development after LT . We analysed 478 LT in 440 patients, and 93 (19.5%) were followed by NC s. The average LOS was longer in patients experiencing NC s. The 1‐, 3‐ and 5‐year graft survival and patient survival were similar in patients with or without a NC . Multivariate analysis showed the following as independent risk factors for NC : a MELD score ≥20 ( OR = 1.934, CI = 1.186–3.153) and an immunosuppressive regimen based on calcineurin inhibitors ( CNI s) ( OR = 1.669, CI = 1.009–2.760). Among patients receiving an everolimus‐based immunosuppression, the 7.1% developed NC s, vs. the 16.9% in those receiving a CNI ( P = 0.039). There was a 1‐, 3‐ and 5‐year NC ‐free survival of 81.7%, 81.1% and 77.7% in patients receiving a CNI ‐based regimen and 95.1%, 93.6% and 92.7% in those not receiving a CNI ‐based regimen ( P < 0.001). In patients undergoing a LT and presenting with nonmodifiable risk factors for developing NC s, an immunosuppressive regimen based on CNI s is likely to result in a higher rate of NC s compared to mTOR inhibitors.