Possible therapeutic effect of lipid supplementation on neurotoxicity in liver transplant recipients

Neurotoxicity represents a serious complication following liver transplantation and may be evoked by various perioperative factors or develop due to toxicity of immunosuppresion. The symptoms of neurotoxicity associated with calcineurin inhibitors (CNIs) may be reversed by discontinuing or reducing the dose of CNIs; however, this may increase the risk of rejection. To address this issue, we examined 45 adult living donor liver transplant recipients. At the time of neurotoxicity diagnosis, serum cholesterol values were significantly lower in the patients with neurotoxicity than in those without neurotoxicity. Based on our hypothesis that lipid supplementation prevents lipophilic CNIs from crossing the blood-brain barrier, soybean oil was administered to 5 patients with neurotoxicity. In all these patients, the neurological symptoms improved without discontinuing or reducing the dose of CNIs. This use of this therapy may help in avoiding insufficient immunosuppressive therapy because neither dose reduction nor substitution of CNIs would be then required.