Neurological Complications after Liver Transplantation According to Immunosuppressive Therapy

Abstract

Background: Neurological complications (NC) after liver transplantation (LT) are frequent, appearing in up to 60% of patients. Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections. The use of basiliximab allows for less toxic immunosuppressive therapies. The aim of this study was to evaluate the neurological complications present during the first 30 days after LT and to evaluate its relationship with renal function, immunosuppressive therapy, and mortality. Methods: A total of 231 recipients were included in the retrospective, longitudinal, and nonrandomized study under 2 different immunosuppression protocols (with -group B- or without basiliximab -group A-). Results: NC were present in 14.3% of patients (n: 33), the average age of these patients was 55.4 years. The incidence of NC was significantly higher in group A than in group B (19.5% vs. 9.3% p <0.05), with no differences in the incidence of infection or rejection between both groups. The incidence of acute renal failure, the need for renal replacement therapy, the days of admission to the ICU, the days of hospital admission, as well as mortality during admission and one year after LT were higher among patients with NC. However, when analyzing patients with a neurological complication, patients in group A had a higher incidence of complications than in group B. Conclusion: The use of immunosuppressive therapies that apply lower doses of anticalcineurinics and with a later onset, classically called nephroprotective as used in group B, could also be neuroprotective, reducing the appearance of neurological complications and, therefore, morbidity. These findings most be verified in studies with a larger number of patients and randomized.