An underrated complication of the organs’ transplantations
Sabino Luzzi 1,2, Marco Demasi 1, Alice Giotta Lucifero 1, Anna Simoncelli 4, Sergio Carnevale 5, Patrizia Morbini 6, Alberto Maria Crovace 7,8, Nicola Tartaglia 9, Antonio Ambrosi 9
1 Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
2 Neurosurery Unit, Deparment of Surgical Sciences, Fondazione IRCCS Polilinico San Mate, Pavia Italy
3 School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
4 Diagnostic Radiology, Interventional Radiology and Neuroradiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
5 Anatomic Pathology Section, Cerba Health Care Italia, Milano (MI)
6 Unit of Pathology, Department of Molecular Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
7 Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Bari, Italy
8 Department of Veterinary Medicine, University of Perugia, Perugia, Italy
9 Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
Ann. Ital. Chir. 2020, 91(3), 298–309
Published: 1 May 2020
Abstract
INTRODUCTION: Tacrolimus is routinely used to prevent rejection after organs’ transplantation. Neurotoxicity is underrated side effect, where no typical clinical, radiological, or histopathological patterns have yet been found. The present study is targeted to a review of the literature on tacrolimus-induced neurotoxicity secondary to organs’ transplantation, aimed to its prompt diagnosis. MATERIALS AND METHODS: Multiple PubMed searches were performed to review relevant articles regarding tacrolimusinduced neurotoxicity. An illustrative case is also presented. RESULTS: Twenty articles published between 1997 and 2019 were identified and reviewed. Clinical manifestations of tacrolimus-induced neurotoxicity varied. MRI showed subcortical white matter involvement in most cases. Symptoms and radiological signs occurred at various drug dosages and blood tacrolimus levels. Tacrolimus discontinuation resulted in disappearance or marked reduction of neurological symptoms and imaging lesions in every case. CONCLUSION: Neurotoxicity is an underrated reversible side effect of chronic tacrolimus administration after organs’ transplantation. Its prompt diagnosis, based on T2 and FLAIR MRI sequences neuroimaging combined with stereotactic biopsy, allows the discontinuation of the drug and a recovery of the patient in most of the cases.
