Central pontine myelinolysis and cyclosporine neurotoxicity following liver transplantation

Transplantation. 1996 Feb 27;61(4):658-61. doi: 10.1097/00007890-199602270-00026.


In a recent series of 44 liver transplants we identified both extrapontine myelinolysis (EPM) - characteristic of cyclosporine neurotoxicity - and central pontine myelinolysis (CPM) in 5 recipients posttransplant. An additional 2 recipients had EPM only posttransplant. MRIs performed in 4 asymptomatic recipients were normal. Large perioperative shifts in serum sodium, hypomagnesemia, and high cyclosporine levels may play a role in the development of these lesions, although the evidence from this study is inconclusive. In addition to supportive care, dilantin was started in patients who had seizures; aggressive magnesium replacement was initiated for hypomagnesemia, and cyclosporine levels were reduced in all patients. All patients demonstrated a slow steady recovery and all but 2 are at home at the time of writing. CPM may be more prevalent than previously appreciated following liver transplantation, although its prognosis may not be as dismal.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cholesterol / blood
  • Cyclosporine / adverse effects*
  • Cyclosporine / therapeutic use
  • Demyelinating Diseases / etiology*
  • Electroencephalography
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Liver Transplantation / adverse effects*
  • Magnesium / blood
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myelinolysis, Central Pontine / blood
  • Myelinolysis, Central Pontine / chemically induced
  • Myelinolysis, Central Pontine / etiology*
  • Pons / drug effects
  • Pons / pathology
  • Sodium / blood


  • Immunosuppressive Agents
  • Cyclosporine
  • Cholesterol
  • Sodium
  • Magnesium