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17 May 2022: Original Paper

Tacrolimus-Induced Neurotoxicity in Early Post-Liver Transplant Saudi Patients: Incidence and Risk Factors

Dema A. Alissa 1ABCDEF* , Delal Alkortas 1AE , Mohammed Alsebayel 2AE , Rawan Abdullah Almasuood 3EF , Wejdan Aburas 3EF , Tahani Altamimi 4F , Edward Bentz Devol 5CD , Ahmed H. Al-jedai 16ADE

DOI: 10.12659/AOT.935938

Ann Transplant 2022; 27:e935938

Table 1 Baseline characteristics and confounders associated with the development of early calcineurin inhibitor-induced neurotoxicity (ECIIN) using univariate analysis.

All patients (n=338) (percentage)ECIIN (number (percentage; exact confidence interval))P-value
No. of female patients131 (39%)19 (14.5%; 8.96–21.7)0.1514
No. of living donor transplants171 (51%)34 (20%; 14.18–26.6)0.5787
History of hepatic encephalopathy99 (29%)27 (27%; 18.80–37.15)
History of ascites142 (42%)28 (20%; 13.52–27.22)0.6736
No. of patients on dialysis before transplantation8 (3%)3 (38%; 8.52–75.51)0.1717
ICU admission before transplantation77 (23%)20 (26%; 16.64–37.23)0.0678
No. of patients who had re-transplantation15 (5%)3 (20%; 4.33–48.09)1.0000
History of hypertension (HTN)66 (20%)12 (18%; 9.76–29.61)1.0000
History of diabetes mellitus (DM)124 (37%)22 (18%; 11.47–25.62)0.7741
History seizures4 (1%)2 (50%; 6.76–93.24)0.1593
Hepatic cellular carcinoma (HCC)92 (27%)11 (12%; 6.12–20.39)0.0600
No. of patients who needed re-operation within 4 weeks after transplant55 (16%)20 (36%; 23.81–50.44)
No. of patients who had basiliximab induction134 (40%)28 (21%; 14.36–28.76)0.3952
No. of patients with mean arterial pressure (MAP)79 (23%)10 (13%; 6.24–22.05)0.1386
No. of patients who had dialysis post-transplant21 (6%)8 (38%; 18.11–61.56)
 Hepatitis C virus (HCV)135 (40%)20 (15%; 9.29–21.95)0.1556
 Hepatitis B virus (HBV)80 (24%)15 (19%; 10.89–29.03)1.0000
 Cryptogenic62 (18%)12 (19%; 10.42–31.37)0.8579
 Autoimmune hepatitis (AIH)41 (12%)13 (32%; 18.08–48.09)
 Non-Alcoholic Fatty Liver Disease17 (5%)6 (35%; 14.21–61.67)0.1020
 Primary sclerosing cholangitis (PSC)10 (3%)2 (20%; 2.52–55.61)1.0000
 Schistosomiasis11 (3%)1 (9%; 0.23–41.28)0.6966
 Primary Biliary Cirrhosis7 (2%)1 (14%; 0.36–57.87)1.0000
 Fulminant hepatitis6 (2%)2 (33%; 4.33–77.72)0.3110
 Budd-Chiari7 (2%)2 (29%; 3.67–70.96)0.6186
 Alcoholic liver disease4 (2%)1 (25%; 0.63–80.59)0.5636
 Others5 (2%)0 (0%; 0–52.18)1.0000
Developed CMV infection post-transplantation55 (16%)15 (27%; 16.14–40.96)0.0879
Developed sepsis post-transplantation56 (17%)28 (50%; 36.34–63.66)
Developed DM post-transplantation127 (38%)26 (20%; 13.83–28.54)0.5644
Developed HTN post-transplantation120 (36%)25 (21%; 13.96–29.20)0.4673
 Height (cm)163 (157.3–169)162 (158.5–168.5)0.9061
 Weight (kg)69.8 (59.1–79.08)73.3 (58.65–81.85)0.4077
 BMI (kg/m)25.67 (23.12–29.09)27.59 (23.25–30.30)0.3546
 Age (years)53.58 (44.57–59.81)53.24 (45.7–59.45)0.6022
 MELD score19.5 (15–25)22 (18–29.5)
 SrCr (mmol/L)77 (60.25–105.75)79 (64.5–108)0.7658
 Mg (mmol/L)0.73 (0.63–0.83)0.72 (0.62–0.85)0.9215
 Na (mmol/L)139 (134–142)139 (133–143)0.8682
 Ca (mmol/L)2.11 (1.98–2.24)2.12 (1.96–2.28)0.8372
 Albumin (g/L)29.3 (25.1–34)30.6 (24.6–35.55)0.6290
 Ca corrected (mmol/L)2.3 (2.21–2.4)2.29 (2.19–2.39)0.3584
 Cholesterol (mmol/L)3 (2.1–3.6)3 (1.75–3.55)0.7815
 HDL (mmol/L)0.83 (0.44–1.18)0.62 (0.34–1.01)0.2760
 Triglyceride (mmol/L)0.85 (0.65–1.15)0.95 (0.7–1.29)0.2080
 LDL (mmol/L)1.62 (1.01–2)1.6 (1.06–2.11)0.4404
 Warm ischemia time (Hr)0.76 (0.57–0.95)0.74 (0.64–0.97)0.9618
 Cold ischemia time (Hr)3.06 (2.12–4.58)2.75 (2.19–4.65)0.7445
 Total ischemia time (Hr)3.8 (3.09–5.44)3.49 (3.15–4.89)0.5664
 Units of Packed Red Blood Cells5 (4–9.25)5.5 (4–11)0.2289
 Units of Fresh Frozen Plasma4 (0–9.5)6 (1–10)
 Units of Platelets2 (0–6.75)5 (0–9)0.1225
 SrCr (mmol/L)77 (61–101)81 (59–99)0.8015
 Mg (mmol/L)0.67 (0.53–0.90)0.65 (0.51–0.92)0.9034
 Na (mmol/L)143 (140–147)145 (141.5–148)
 Ca (mmol/L)2.07 (1.94–2.26)2.1 (1.97–2.31)0.2945
 Albumin (g/L)27.1 (23.85–31)27 (23.6–31)0.6085
 Ca corrected (mmol/L)2.33 (2.19–2.50)2.38 (2.24–2.52)0.1290
 Tacrolimus steady-state levels (ng/ml)4 (2.9–6.45)5.05 (2.83–7.45)0.1484

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358