Congress Proceedings - First International Workshop. Neurological Problems and Liver Transplantation: Current perspective on immunosuppression used in liver transplantation with emphasis on neurotoxicity

Since the first successful liver transplant in 1968 by Starzl, survival outcomes have dramatically improved with a resultant increase in the number of transplants performed each year. While there have been improvements in technical and medical approaches to the care of liver transplant patients, probably the single greatest improvement has been in the area of immunosuppressive management. The overall patient survival is currently over 80 at one year and over 60 at nine years. The actuarial nine-year survival in children (aged between 3 and 18 years) is approximately 90. However these improvements have not come about without an associated morbidity. One of the major perioperative complications is the development of neurotoxicity - ranging from mild presentation of tremor and cognitive disorders to major complications of seizure, dysarthria, and cerebropontine myelinolysis. The etiologies of these neurologic complications are multifactorial. The mainstay immunosuppressive agents, cyclosporin and tacrolimus, ave themselves associated with neurotoxicity, and this presentation may be aggravated by post-operative liver dysfunction, renal impairment, metabolic and electrolyte disturbances. Both drugs are inherently nephrotoxic, diabetogenic and hypertensive. Allograft loss from acute and chronic rejection is rare. The majority of late graft losses and deaths are related to: recurrence of disease; non-compliance; the development of de novo malignancies and age-related concurrent medical conditions.