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Chronic inflammatory demyelinating polyneuropathy complicating liver transplantation
B V Taylor1, E F Wijdicks, J J Poterucha
1Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Annals of Neurology
|November 1, 1995
Summary
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developed after a liver transplant for hepatitis B. Reduced immunosuppression may have triggered CIDP, which improved with plasma exchange and IVIG.
Area of Science:
- Neurology
- Hepatology
- Immunology
Background:
- Liver transplantation is a life-saving procedure for end-stage liver disease.
- Hepatitis B virus (HBV) can cause fulminant hepatic failure, necessitating liver transplantation.
- Immunosuppression is crucial post-transplant but can be complex to manage.
Observation:
- A patient developed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) after liver transplantation for HBV-induced fulminant hepatic failure.
- A potential symptomatic recurrence of HBV in the liver graft led to a reduction in cyclosporine dosage.
- This reduction in immunosuppression is hypothesized to have triggered an immune response leading to demyelination.
Findings:
- The patient experienced a relapse of neurological symptoms consistent with CIDP.
- Treatment with plasma exchange and subsequent intravenous immunoglobulin (IVIG) resulted in significant clinical improvement.
- This suggests a link between altered immunosuppression and the development of CIDP in this context.
Implications:
- This case highlights a potential neurological complication following liver transplantation, specifically CIDP.
- It underscores the delicate balance of immunosuppression management in transplant recipients.
- Further research may explore the immunopathogenesis of CIDP in post-transplant settings and the role of immunosuppressive drug modulation.