Abstract：
Tacrolimus, a calcineurin inhibitor, is an immunosuppressant used globally to prevent rejection after organ transplantation. Although it significantly improves outcomes for solid organ transplant patients, it is associated with various side effects such as nephrotoxicity and neurotoxicity. Tacrolimus-induced neurotoxicity is frequently encountered in clinical practice and can present with a variety of symptoms that may occur even at therapeutic levels. Although tacrolimus-induced neurotoxicity is well documented, there is limited literature available on pharmacologic management. Twenty-eight case reports of tacrolimus-induced neurotoxicity were identified and analyzed in addition to other literature including reviews, retrospective studies, and animal model studies. The severity of cases of tacrolimus-induced neurotoxicity reported ranged from mild symptoms that could be managed with symptomatic treatment to conditions such as posterior reversible encephalopathy syndrome and chronic inflammatory demyelinating polyradiculoneuropathy that may require more immediate intervention. This information was utilized in addition to clinical experience to compile potential management options for prevention and treatment of neurotoxic adverse events. This review is limited by the utilization of primarily retrospective studies and case reports. The available literature on the subject is largely narrative and there are no guidelines on treatment of tacrolimus-induced neurotoxicity at the time of this research. This comprehensive review may guide further studies to investigate the pathophysiology of tacrolimus-induced neurotoxicity and to define patient-specific strategies for mitigation or minimization of neurotoxicity. This is especially important given that management of tacrolimus-induced neurotoxicity can include changes to immunosuppression that can result in an increased risk of rejection.
摘要：
他克莫司,钙调磷酸酶抑制剂,是一种免疫抑制剂，在全球范围内用于预防器官移植后的排斥反应。虽然它显著改善了实体器官移植患者的预后，它与各种副作用有关，如肾毒性和神经毒性。他克莫司诱导的神经毒性在临床实践中经常遇到，并且可以表现出即使在治疗水平也可能发生的多种症状。虽然他克莫司诱导的神经毒性是有据可查的，关于药物管理的文献有限.除了包括综述在内的其他文献外，还对28例他克莫司诱导的神经毒性的病例报告进行了鉴定和分析。回顾性研究,和动物模型研究。报告的他克莫司诱导的神经毒性病例的严重程度从可以通过对症治疗控制的轻度症状到可能需要更立即干预的后部可逆性脑病综合征和慢性炎性脱髓鞘性多发性神经根神经病等病症。除了临床经验外，该信息还用于编制预防和治疗神经毒性不良事件的潜在管理选项。本综述受到主要采用回顾性研究和病例报告的限制。关于该主题的现有文献主要是叙述性的，并且在本研究时没有关于他克莫司诱导的神经毒性的治疗指南。这项全面的综述可以指导进一步的研究，以研究他克莫司诱导的神经毒性的病理生理学，并定义缓解或最小化神经毒性的患者特异性策略。考虑到他克莫司诱导的神经毒性的管理可能包括免疫抑制的改变，这可能导致排斥风险增加，这一点尤其重要。
