The course and prognostic factors of familial amyloid polyneuropathy after liver transplantation

• Tipo: Artigo em Revista Científica Internacional
• Data: 2000

Autores

adams, d (Autor) Outra; samuel, d (Autor) Outra; goulon-goeau, c (Autor) Outra; nakazato, m (Autor) Outra; costa, pmp (Autor) ICBAS; feray, c (Autor) Outra; plante, v (Autor) Outra; ducot, b (Autor) Outra; ichai, p (Autor) Outra; lacroix, c (Autor) Outra; metral, s (Autor) Outra; bismuth, h (Autor) Outra; said, g (Autor) Outra

Revista

Título: Brain

Vol. 123

Páginas: 1495-1504

ISSN: 0006-8950

Editora: Oxford University Press

Indexação

ISI Web of Knowledge - 126 Citações

Scopus - 151 Citações

Classificação Científica

FOS: Ciências médicas e da saúde > Medicina clínica

Outras Informações

ID Authenticus: P-000-ZJB

DOI: 10.1093/brain/123.7.1495

Abstract (EN): Familial amyloid polyneuropathy (FAP) associated with mutations of the transthyretin (TTR) gene is the most common type of FAP, a devastating disease causing death within 10 years after the first symptoms. Because most of the amyloidogenic mutated TTR is secreted by the li,er, transplantation is widely used to treat these patients, but long-term quantitative evaluation of the effects of liver transplantation on the progression of the neuropathy are not available, We have treated 45 patients with symptomatic TTR-FAP, including 43 with the Met30 TTR gene mutation, and report on the results of periodic evaluation of markers of neuropathy in 25 of them, who have been followed for more than 2 years after liver transplantation (mean follow-up 3 years). The overall survival rates at 1 and 5 years were 82 and 60%, respectively. Urinary incontinence and a low Norris score at liver transplantation were associated with poorer outcome. The motor score stabilized in seven of 11 patients (64%) with mild sensorimotor neuropathy (walking unaided) and in two of the eight patients (25%) with severe sensorimotor deficit (walking with aid) at liver transplantation. In five other patients, deterioration of motor deficit occurred only within the first year after liver transplantation, but was progressive after this interval in two patients. None of the sis patients with pure sensory neuropathy developed motor loss and superficial sensory loss remained unchanged. Two Sears after liver transplantation, the rate of myelinated axon loss in nerve biopsy specimens was markedly lower in seven transplanted patients (0.9/mm(2) of endoneurial area/month) than in non-transplanted patients (70/nm(2) of endoneurial area/month). Symptoms of dysautonomia and quantitated cardiocirculatory autonomic tests remained unchanged. In all patients, serum mutated TTR decreased to 2.5% of pre-liver transplantation values and remained at this level during follow-up. We presently recommend liver transplantation in FAP patients at onset of first symptoms and exclusion of those with a Norris score below 55 and/or with urinary incontinence.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 10