Cyclosporine associated acute cerebellar syndrome after liver transplantation

158 I co1/031

PLATELET ACTIVITY BECAUSE CARCINPID

SEROTONIN (5HT) AND MAO-B IN A PATIENT UNDERGONE OLT OF METASTASES FROM MIDGUT TUMOR

F. SzJav , D. .Borcsiczkv!, Zs. Meszaros’, K. Tekes’. , G. Dallos’,V. Reti’, D. Goriia”, F._Pemer’ 1st Dept. of MedicinT’ Dept of Pharmacodynamics’, Dept. of Transplatation , Semmelweis Medical University, Budapest, Hungary Primary carcinoid tumor in the ileum and numerous metastases in both lobes of the liver were diagnosed in a 47year -old male patient. The primary tumor together with one meter portion of ileum and right colon has been removed because of adjoining mesenterial mass. Four month later liver transplantation (OLT) was performed. Cyclosporin and from the 3rd month FK506 have been used for immunosuppression. The patient is well 18 months after the OLT. The former symptoms as diarrhea, flushes, dyspnea are not present, he has gained weight. Method: Platelet 5HT content was determined by HPLC with EC detector before the transplantation and monitored after that. Platelet MAO-B activity was also measured. Result: The very high pretransplantation serotonin value (5 127 ng/109 platelet) continously decreased after OLT. After four weeks, it was almost normal (1316 ng/109plt). A transitional elevation was observed at six months (2006 ng/lO’plt), but no recurrence of the tumor was found. Between one year and 18 months after OLT, the platelet 5HT values were within the normal range (600-900 ng/lO’plt). The platelet MAO-B activity correlated with the serotonin values. Conclusion: The determination of platelet serotonin is an appropriate method for monitoring patients with carcinoid syndrome even after OLT. Patient:

Supported by OTKA

1 co1/030

and ETT grants

1

DETECTION OF LIVER FUNCTION AFTER LIVER TRANSPLANTATION

WITH MEG-X

TEST

T Co&o, V Cot&, A Risaliti’, V Boofmscbi,F Cola’, A Donini’, M Pirisi”, G Aoania*, F Bms&ols*. Dqwtmcm of Anaesthesidw, ‘Depaawntof Surgery, hDepartmenl of lntemal Medicine, University of Udioe School of Medieine,Udioe,ltaty lntrodoctian: Measummentsof hepatic lidocaitx metabolismto its primary mctrbolii monc&ylgly&eqlcdide (MEG-X) has ken demonsw to provide a rapid and mprodueibleassaumcnt oftbehepaticfunctka.weused MEG-X test in liver tmnsplrmtmcipieotsto ptxhct mavery of the liver fiurtion alla traospkttatioa. Methods: A total of 35 liva tmnsplatt rccipieotshave beca cagiderai for this study. A bohu of lidocaioe(lmg/lq bcdy weight) was admmwcdinfravams.Blocd samples(I ml) were witbdmwnat tii 0 (TO) kfac lidocclirrinjccticmand IS (TI) sod 30 (T2) minutesafter the drug was

. tdmuu&d MEG-X tevels in semm were measuredby fly-

mmmmasq using(I TDx analaqer MEG-X test were performed on poatqawive day I (Dl) and 3 (D3). Vahtes of MEG-X at Tl nodT2 on DI and D3 were correlatal to tbe liva fiurtioa teat (AST,ALT, LDH, Alkboe Total and Direct Biliiio). Resnh~: The meao phorpbrtrrc, Cboli=t==, vllues of MEG-X test on Dl and D3 am shown io fig. I. MEG-x was found to cc&ate signifonly uitb total and direct biliibm levels.Go Dl R2 is 0.58 for total bilirubinnod 0,59 for direct bihrubin;tile cm D3 R* is 0.72 for m total and dir@ bilirubm. Conclusion: The ccmelatioowe f& between the MEG-X and bilimbio suggestthat bilirubin shouldk a reliabk sod simpletest to suea bcpatietime&m. In liver tmosplaotrecipientsMEG-X is a good index of timc4ioMlmcowy. Fiti. 1 D1 D3 Tl T2 Tl T2 MEG-X 71.7k51.3 72.0i45.3 83.8f47.3 80.5i41.8 f&ml) pal-:

I

CYCLOSPORINE

ASSOCIATED

SYNDROME AFl-ER

ACUTE

CEREBELLAR

LIVER TRANSPLANTATION

A Risditi, V Como, G Marc&, M Piisi’, G So&o*, MG Bull&n, M Del Fano’,A Donini, F Bmsadola.Deparbwt of Surguy, oDqutmeot of Neurolw, t,“““” of lnternd McdicioeUnivemityof Udioe Schoolof Medicine,Udioe

Intraduction:Neumtoxic e&as of medicationsuch as cydosporioearc pmwlent in patientsm&xgoiag liver traosplaotation.Mild to scvcrcnemdogicalsideeffects as a sequelaof cylosporioe admioistratioahave ball described.Isolatedcerebellar dysfuoctioodue to cyclospotinebatment is ram and in the senings of liver transplantationa few caseshave bceo rqxted mostlyio children.Car report: A caseof e 42 year old mao, alto undawot o&otopic liver emsplantatioofor Child B HBV and alwhol related liver cirrhosisis report&. Triple immtmosuppmssivc therapy with cydospofioe, wathioprine and steroids was startal oo the fust postoperativeday. The lirst dose of cycloqorine was admioisteredinbwaously: followingdoseswere adminiiterai orally with the aim to obtaincyclospaine&a&b level mngiogbchran 250-350 n&ml. Daily mcasumdtroughlevelsnew exaded tk tkqwtic range. Saum levels of magocsiuoratged 6aa 0,53 to 0,63 mmol/L sod choksteroi was 1I3 me/d. Go the 6th pcstqxmtive day k develqxd mild dysanhrir. The followiog day, k had se&es followd by “ab iogcstis” ptwmmia. A w evalumion revealed a sevem dywthria, dysmetfiasod ataxia, fust gmdcoytagmus nodhypotonia;consciaunessH’s(lfull! pmsewcd end oo focal iigns wm observed.No sigoifiit abnamditiea wx famdataCSFexamiwionaodatEEG.CTandMRlscaaofthebminwcm mrmd. Intenqtkm of eycloqnioe admini& was followedby progmssive mcovcry and the pa&t was discbar.@ on the 35th postqxrative day. Liver timction was excelknt Cyclosprxinewas titutod with wolinms, k WI macntauudonauthiopriDecnd~doseofstaoidrandkstillbdavaymild Et: onllmlusion: We ybsavcd a pmz, acute cabelk sytdmme tnaoKnt m no adult liver transplant mcipicnt. This sy&omcwa!inc4doser&tedandmmittedwmplotcly~tlcltcydospainc administmtionwas disc4atimud and substitutedwith taaulimus. It that ~aj~yoro~~compliitioos, such as epileptic seizurea 6od focal oeural oelvoussystemflle~0funbKnrnfauseIulddonot ‘appearto k dwe mlatcdbut am mvexsiblein mostof the patients