Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: A single-center study

Chiara Crivellin, Annachiara Cagnin, Renzo Manara, Patrizia Boccagni, Umberto Cillo, Paolo Feltracco, Stefania Barbieri, Alberto Ferrarese, Giacomo Germani, Francesco Paolo Russo, Patrizia Burra, Marco Senzolo

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1257-1264
Number of pages8
JournalTransplantation
Volume99
Issue number6
DOIs
Publication statusPublished - Jun 6 2015

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Central Pontine Myelinolysis
Liver Transplantation
Hypernatremia
Serum
Nervous System
Control Groups
Hepatic Encephalopathy
Hyponatremia
Immunosuppression
Liver Diseases

ASJC Scopus subject areas

  • Transplantation
  • Medicine(all)

Cite this

Crivellin, C., Cagnin, A., Manara, R., Boccagni, P., Cillo, U., Feltracco, P., ... Senzolo, M. (2015). Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: A single-center study. Transplantation, 99(6), 1257-1264. https://doi.org/10.1097/TP.0000000000000496

Risk factors for central pontine and extrapontine myelinolysis after liver transplantation : A single-center study. / Crivellin, Chiara; Cagnin, Annachiara; Manara, Renzo; Boccagni, Patrizia; Cillo, Umberto; Feltracco, Paolo; Barbieri, Stefania; Ferrarese, Alberto; Germani, Giacomo; Russo, Francesco Paolo; Burra, Patrizia; Senzolo, Marco.

In: Transplantation, Vol. 99, No. 6, 06.06.2015, p. 1257-1264.

Research output: Contribution to journalArticle

Crivellin, C, Cagnin, A, Manara, R, Boccagni, P, Cillo, U, Feltracco, P, Barbieri, S, Ferrarese, A, Germani, G, Russo, FP, Burra, P & Senzolo, M 2015, 'Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: A single-center study', Transplantation, vol. 99, no. 6, pp. 1257-1264. https://doi.org/10.1097/TP.0000000000000496
Crivellin, Chiara ; Cagnin, Annachiara ; Manara, Renzo ; Boccagni, Patrizia ; Cillo, Umberto ; Feltracco, Paolo ; Barbieri, Stefania ; Ferrarese, Alberto ; Germani, Giacomo ; Russo, Francesco Paolo ; Burra, Patrizia ; Senzolo, Marco. / Risk factors for central pontine and extrapontine myelinolysis after liver transplantation : A single-center study. In: Transplantation. 2015 ; Vol. 99, No. 6. pp. 1257-1264.
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T1 - Risk factors for central pontine and extrapontine myelinolysis after liver transplantation

T2 - A single-center study

AU - Crivellin, Chiara

AU - Cagnin, Annachiara

AU - Manara, Renzo

AU - Boccagni, Patrizia

AU - Cillo, Umberto

AU - Feltracco, Paolo

AU - Barbieri, Stefania

AU - Ferrarese, Alberto

AU - Germani, Giacomo

AU - Russo, Francesco Paolo

AU - Burra, Patrizia

AU - Senzolo, Marco

PY - 2015/6/6

Y1 - 2015/6/6

N2 - 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.

AB - 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.

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