Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation

Jonathan P. Fryer*, Marielle V. Fortier, Peter Metrakos, Deborah J. Verran, Sami K. Asfar, David M. Pelz, William J. Wall, David R. Grant, Cameron N. Ghent

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


In a recent series of 44 liver transplants we identified both extrapontine myelinolysis (EPM)-characteristic of cyclocosporine neurotoxicity-and central pontine myelinolysis (CPM) in 5 recipients posttransplant. An additional 2 recipients had EPM only posttransplant. MRIs performed in 4 asymptomatic recipients were normal. Large perioperative shifts in serum sodium, hypomagnesemia, and high cyclosporine levels may play a role in the development of these lesions, although the evidence from this study is inconclusive. In addition to supportive care, dilantin was started in patients who had seizures; aggressive magnesium replacement was initiated for hypomagnesemia, and cyclosporine levels were reduced in all patients. All patients demonstrated a slow steady recovery and all but 2 are home at the time of writing. CPM may be more prevalent than previously appreciated following liver transplantation, although its prognosis may not be as dismal.

Original languageEnglish (US)
Pages (from-to)658-661
Number of pages4
Issue number4
StatePublished - Feb 27 1996

ASJC Scopus subject areas

  • Transplantation


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