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Tacrolimus-induced optic neuropathy after multivisceral transplantation

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Tacrolimus is currently the most commonly prescribedimmunosuppressant. Tacrolimus allowed intestinaltransplantation (ITx) to become a clinical reality by significantly reducing rejection rates in this highly immunogenic organ. Despite its effectivity, tacrolimus can cause severe neurological complications. Specifically, tacrolimus can lead to neuropathy and posterior reversible encephalopathy syndrome (PRES). The exact mechanism is not fully understood, but both direct neurotoxicity- and vasoconstriction-inducedischemic damage have been proposed. One particular form,tacrolimus-induced optic neuropathy (TION) leading to severevisual loss, has been described after solid-organ transplantation. The clinical course of TION can vary substantially, including the degree of vision loss, ophthalmological findings, and subsequent recovery. As there is no pathognomonic sign, the diagnosis is made after excluding other causes such as inflammatory diseases, stroke, infections, and metabolicproblems.The definitive diagnosis is often only made after clinical improvement following withdrawal of tacrolimus.This is possible in most solid-organ transplants but is particularly difficult after ITx where tacrolimus is vital to prevent rejection. We describe a rare case of late-onset, severe, bilateral TION after multivisceral transplantation (MVTx) that was successfully treated while also avoiding rejection.
Tijdschrift: Transplantation direct
ISSN: 2373-8731
Volume: 6
Pagina's: 1 - 6