Central pontine myelinolysis after liver transplantation

Estol, Conrado J.; Faris, Amin A.; Martinez, A. J.; Ahdab-Barmada, Mamdouha

doi:10.1212/wnl.39.4.493

Cited by 108 publications

(47 citation statements)

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“…Nevertheless, close monitoring of electrolytes pre-, peri- and postoperatively is indispensable and correction of hyponatremia should be performed according to the recommended rate of correction. Moreover, if neuropsychiatric disorders develop after liver transplantation, CPM should be considered in the course of differential diagnosis and should be excluded with the help of magnetic resonance tomography taking into account the diagnostic window described below [35]. …”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Central Pontine Myelinolysis

Lampl

Yazdi²

2002

Eur Neurol

225

143

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Central pontine myelinolysis (CPM) is a demyelinating disease of the pons often associated with demyelination of other areas of the central nervous system (CNS). The term ‘osmotic demyelinization syndrome’ is used for pontine and extrapontine myelinolysis. In this paper, we are concerned with CPM although the extrapontine one is based on the same pathogenesis. Both share the diagnostic methods, and their prevention and therapy are the same. The etiology and pathogenesis of this disorder are unclear and will be discussed. However, almost all cases of CPM are related to severe diseases. Chronic alcoholism is still the most common underlying condition of CPM patients. In the literature, 174 cases of CPM have been reported in alcoholics since 1986, which is equivalent to an incidence of 39.4%. Likewise, 95 cases of CPM following the correction of hyponatremia have been documented since 1986 (21.5%). The role of hyponatremia and its correction will be outlined in the discussion of the pathogenesis of CPM. The third largest group of CPM cases are liver transplant patients (17.4%), with the development of CPM being attributed to the immunosuppressive agent cyclosporine in particular. Depending on the involvement of other CNS structures, the clinical picture can vary considerably. The large-scale introduction of magnetic resonance imaging has increasingly facilitated the antemortem diagnosis of CPM, although the radiological findings lag behind and do not necessarily correlate with the clinical picture. As yet, there is no specific therapy of choice. A number of therapeutic approaches have been tested and although they have not been compared with regard to their rate of success, they have all led to a substantial improvement in the prognosis of CPM.

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Section: Etiology and Pathogenesismentioning

confidence: 99%

Central Pontine Myelinolysis

Lampl

Yazdi²

2002

Eur Neurol

225

143

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“…Central pontine myelinolysis/extrapontine myelinolysis (CPM/EPM) is a serious complication that can occur in patients who undergo orthotopic liver transplantation (OLT) [1,2,3], with an incidence varying from 0.94 to 1.2% [4,5,6]. Hyponatremia or its rapid correction has been reported to be associated with CPM/EPM [2,3,7].…”

Section: Introductionmentioning

confidence: 99%

“…Hyponatremia or its rapid correction has been reported to be associated with CPM/EPM [2,3,7]. In addition to hyponatremia, other electrochemical imbalances, as well as clinical factors such as pretransplant hepatic encephalopathy, malnutrition or treatment with cyclosporine or FK506 may be risk factors for CPM/EPM [8,9,10,11,12,13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Central Pontine and Extrapontine Myelinolysis following Orthotopic Liver Transplantation

Lee

Kang²,

Yun³

et al. 2009

Eur Neurol

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Background: Central pontine myelinolysis (CPM)/extrapontine myelinolysis (EPM) is one of the most serious neurological complications that can occur after orthotopic liver transplantation (OLT). We analyzed the risk factors for CPM/EPM in OLT patients. Methods: We retrospectively reviewed the records of 1,247 patients who underwent OLT between 1992 and 2005. We compared demographic, clinical and biological parameters of patients with CPM/EPM with those of age-, sex- and operation date-matched patients without CPM/EPM (controls). Results: Of 1,247 patients, 11 (0.88%) were diagnosed with CPM/EPM based on neuroimaging findings. A higher Model for End-Stage Liver Disease-Na score, preoperative hyponatremia and hypocholesterolemia, as well as greater changes in electrolytes, especially sodium, during surgery, were observed in the CPM/EPM group (p < 0.05). Conclusion: CPM/EPM after OLT is more likely to occur in patients with more severe preoperative liver dysfunction and greater changes in electrolyte imbalance, especially sodium, during surgery.

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“…Not only have prior data shown that pre-operative hyponatremia is relatively common and a negative prognostic factor, it has also been associated with an increased iatrogenic risk of post-operative ODS. 15,17,19,[23][24][25][26] In a 10-year retrospective surveillance of 2175 patients undergoing LTx, Yun et al 9 found the development of post-operative ODS occurred in 0.5% of patients and was correlated with a lower preoperative SNa (129 vs. 136 mmol/L). Previous studies also linked pre-operative hyponatremia to an increased risk of rapid SNa shift and undesired complications.…”

Section: Interpretation and Context With Prior Literaturementioning

confidence: 99%

Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study

et al. 2014

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We aimed to describe the pre-operative incidence of hyponatremia in patients undergoing liver transplantation (LTx), as well as the rate and consequences of rapid perioperative sodium rises in these patients. Methods: This was a retrospective before and after observational study performed at a University-affiliated LTx center between January 2007 and June 2013. The primary exposure was pre-operative hyponatremia, defined as a serum sodium (SNa) 5133 mmol/L. The primary outcome was occurrence of a rapid SNa shift, defined as 10 mmol/L in the first 24 h following LTx. The rates of rapid peri-operative SNa shift were compared before and after a focused quality assurance (QA) initiative performed in July 2009. Results: Of 366 LTx, 69 (18.9%) had pre-operative hyponatremia, 6 (8.7%) of whom had a rapid rise in serum sodium (SNa). Rapid rise was associated with a greater intra-operative positive fluid balance (p50.001) and use of intra-operative continuous renal replacement therapy (CRRT) (p ¼ 0.017). A rapid rise in SNa was associated with more neurological investigations in the post-transplant period (brain computed tomography, electroencephalogram, swallow studies), increased neurological deficits (p ¼ 0.006), more abnormal swallowing assessments (p ¼ 0.003), a tendency for more neurology consultations (p ¼ 0.058), increased discharge to a rehabilitation or long-term care facility (p50.001), and increased 6-month mortality (p50.001). Following a QA initiative, rapid peri-operative rises in SNa among hyponatremic patients was significantly reduced (20% vs. 0%, p50.003). Conclusion: Pre-operative hyponatremia and rapid peri-operative SNa shifts are associated with a more complicated post-operative course and worse outcomes following LTx. Increased education and awareness, along with process changes, such as standardizing CRRT prescription, can reduce iatrogenic rapid peri-operative shifts in SNa.

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Central pontine myelinolysis after liver transplantation

Cited by 108 publications

References 0 publications

Central Pontine Myelinolysis

Central Pontine Myelinolysis

Risk Factors for Central Pontine and Extrapontine Myelinolysis following Orthotopic Liver Transplantation

Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study

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