Quantitative magnetic resonance imaging indicates brain tissue alterations in patients after liver transplantation.

Goede, Lukas Laurids ORCID; Pflugrad, Henning GND; Schmitz, Birte; Lanfermann, Heinrich; Tryc, Anita Blanka; Barg-Hock, Hannelore; Klempnauer, Jürgen GND; Weißenborn, Karin GND; Ding, Xiao-Qi

PURPOSE:To investigate cerebral microstructural alterations in patients treated with calcineurin inhibitors (CNI) after orthotopic liver transplantation (OLT) using quantitative magnetic resonance imaging (qMRI) and a cross-sectional study design. METHODS:Cerebral qMRI was performed in 85 patients in a median 10 years after OLT compared to 31 healthy controls. Patients were treated with different dosages of CNI or with a CNI-free immunosuppression (CNI-free: n = 19; CNI-low: n = 36; CNI-standard: n = 30). T2-, T2*- and T2'- relaxation times, as well as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured in brain gray and white matter by using the regions of interest method. RESULTS:In comparison to controls, patients revealed significantly increased T2, T2*, T2', ADC and reduced FA, predominantly in the frontal white matter, indicating microstructural brain alterations represented by increased free water (increased T2), reduced neuronal metabolism (increased T2') and a lower degree of spatial organization of the nervous fibers (reduced FA). CNI-low and CNI-free patients showed more alterations than CNI-standard patients. Analysis of their history revealed impairment of kidney function while under standard CNI dose suggesting that these patients may be more vulnerable to toxic CNI side-effects. CONCLUSION:Our findings suggest that the individual sensitivity to toxic side effects should be considered when choosing an appropriate immunosuppressive regimen in patients after liver transplantation.

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Goede, Lukas / Pflugrad, Henning / Schmitz, Birte / et al: Quantitative magnetic resonance imaging indicates brain tissue alterations in patients after liver transplantation.. 2019.

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