Relationship Between Blood Concen-tration Of Tacrolimus And Neurotoxic Reactions After Liver Transplantation

Backgrounds:Liver transplantation started in the end of 1970s in the 20th in our country,but it did not develop quickly untill in the end of 1990s,As surgical skill,the management of the perioperative period and the cure of immune control developing continuously and getting a great breakthrough,liver transplantation have gotten a rapid improvement.Through the rate and the quantity of exietence after liver transplantation have been improved,the syndrome in the near future or at a specified future date after operation still exist,especially neurotoxic reactions is still an important subject of each transplantion center.Objective:Discussion relationship between blood concentration of tacrolimus and neurotoxic reactions after liver transplantation and its treatment.Method:from January 2005 to January 2009 between the 110 cases after liver transplantation application of tacrolimus + mycophenolate mofetil + methylprednisolone triple immunosuppressive therapy of patients.Monitoring of blood concentration of tacrolimus observed aider the first 7 to 30 day neurotoxic reactions(including excitement and inhibition type),compared happen and not happen neurotoxic reactions in patients with他克莫司blood concentration.Result:Postoperative incidence of neurological toxicity rate of 25.8 percent, which accounted for 77.4 percent excited type,accounting for 22.6 percent inhibition type;92.2 percent happened at the first postoperative day 7 to 21.All occurred in patients with neurological toxicity,excited type and inhibition type,respective tacrolimus blood concentration were significantly higher than the average does in patients without neurotoxic reactions(P＜0.05).A variety of nervous system toxicity in the limb tremor,insomnia and logorrhea many exciting phrase the highest incidence of symptoms,and three of their respective tacrolimus blood trough concentration values were significantly higher than average occurrence of neurological toxicity in patients(P＜0.05).After adjusted dose,the biood concentration decreased,while psychiatric symptoms have improved or disappeared in 17 cases.One cases of patients with symptoms of serious drug dose adjustments after no significant improvement in symptoms,will be replaced by cyclosporine tacrolimus after the symptoms gradually disappear.Another one cases of patients with reduced biood concentration at 15ng/ml the following after the performance for suicidal tendencies,questioning its history,has found that family history,to be improved after symptomatic treatment.Conclusion:tacrolimus blood concentration level of liver transplantation are caused by early postoperative complications of the nervous system important factor. Adjust dosage at the same time,coupled with the use of sedative drugs,the majority of patients with psychiatric symptoms had improved,For severe symptoms after dose adjustment in patients with no significant improvement in symptoms,they will be replaced by taerolimus after cyclosporine symptoms gradually disappear.So consider the spirit of drug side-effects caused by the possibility of large abnormal.