Analysis of liver function test abnormalities in kidney transplant recipients: 7 year experience.

OBJECTIVE: Immunosuppressive drugs, antimicrobial agents and infectious complications may cause liver function test abnormalities (LFTA) in kidney transplant recipients (KTR). The objectives of this study were to identify the outcome of (LFTA). To identify the risk factors affecting development and severity of hepatotoxicity in KTR. METHODS: We retrospectively evaluated the medical records of KTR. Hepatotoxicity attacks were defined as impairment in liver function tests that was responsive to drug dose reduction or discontinuation, or treatment of specific causes such as infectious complications. RESULTS: One hundred-fifty-six episodes of hepatotoxicity occurred in 107 patients in 281 KTR, with an incidence of 38%. Patients with hepatotoxicity episodes had a high total mortality rate, higher incidence of positive pre-transplant cytomegalovirus (CMV) IgM test, higher creatinine values during the first month post-transplant, underwent additional acute rejection episodes, and received fewer cyclosporin A based ID. Only positive CMV IgM testing was identified as a significant independent risk factor for hepatotoxicity in our multiple analysis. Mycophenolatemofetil (MMF) related hepatotoxicity was the most common cause of drug related LFTA. CONCLUSIONS: Patients with LFTA can have significant complications. Pre-transplant positive CMV IgM tests predispose transplant recipients to the development of LFTA during the post-transplant period. MMF can be a serious hepatotoxic drug.

Critical flicker frequency test for diagnosing minimal hepatic encephalopathy in patients with cirrhosis.

BACKGROUND/AIMS: The critical flicker frequency (CFF) and psychometric hepatic encephalopathy score (PHES) are commonly proposed tests for detecting minimal hepatic encephalopathy (MHE); however, no studies have examined their value for detecting MHE in Turkey. MATERIALS AND METHODS: A total of 70 patients with cirrhosis without overt HE, 205 controls for PHES, and 100 controls for the CFF test were included. All the patients underwent the PHES and CFF tests during the same session. Psychometric tests comprising number connection test A and B, digit symbol test, serial dotting test, and line drawing test were used. Tests were considered abnormal when test score was more than mean ± 2 standard deviations in comparison with that of the age- and education-matched controls. MHE was diagnosed when ≥2 PHES test were abnormal, and CFF was <39 Hz. RESULTS: The prevalence of MHE among the 70 patients with cirrhosis, as measured by the CFF and PHES tests, was 41.4% (29) and 30.7% (25), respectively. The mean CFF was significantly lower in patients with cirrhosis having MHE (38.3±1.2 Hz) than in patients with cirrhosis not having MHE (42.6±2.3 Hz; p=0.001) and in controls (44.84 ± 3.7 Hz; p=0.001). With a cutoff value of <39, CFF had a sensitivity of 39%, specificity of 82%, and diagnostic accuracy of 70.6% for detecting MHE. CONCLUSION: The CFF test is also a useful method for detecting MHE in xxx patients with cirrhosis. However, the CFF test should be used as an adjunct to the PHES test because of its low sensitivity for detecting MHE.

Terlipressin-induced ischemic skin necrosis: a rare association.

BACKGROUND: Terlipressin is a synthetic vasopressin analogue that is used in the treatment of bleeding esophageal varices and hepatorenal syndrome in patients with cirrhosis. Serious ischemic adverse events, such as skin necrosis involving the extremities, scrotum, trunk, and abdominal skin, are rarely observed. In the literature to date, 20 cases that developed ischemic skin necrosis due to terlipressin usage have been reported. CASE REPORT: We report a patient with extensive skin necrosis on the infusion site of the right forearm and hand, which developed after the use terlipressin used to treat bleeding oesophageal varices in a 65-year-old man with cirrhosis. CONCLUSIONS: Although rare, ischemic complications of terlipressin do occur.