Abstract: FR-PO1000

Autonomic Nervous System Dysfunction Status Post Solid Organ Transplant

Session Information

Category: Transplantation

  • 1701 Transplantation: Basic and Experimental

Authors

  • Tazi, Nina, Mayo Clinic, Scottsdale, Arizona, United States
  • Keddis, Mira T., Mayo Clinic, Phoenix, Arizona, United States
Background

Introduction:
Autonomic nervous system (ANS) dysfunction has been reported to stabilize or improve following solid organ transplantation. This paper describes the phenomenon of ANS dysfunction, that happens within 30 days of solid organ transplant (kidney, kidney-pancreas or liver), requiring multiple medications, and ultimately resolves over several months.

Methods

Materials and methods:
All patients who underwent solid organ transplant from 2012-2016 and were evaluated by neurology after transplant were included (n=8). Data gathered included pre transplant autonomic dysfunction, post-transplant BP, laboratory variables and paraneoplastic antibodies.

Results

Results:
A total of 8 patients were identified who suffered severe symptoms of ANS dysfunction including symptoms of orthostatic intolerance and syncope in all, and significant gastrointestinal symptoms in 7 that began concurrently with adrenergic failure. Symptoms of ANS dysfunction occurred 1 - 3 weeks post-transplant. Symptoms present post-transplant included lower blood pressure, hypoalbuminemia, anemia requiring transfusion in 5 of 8 patients. Paraneoplastic autoantibody panel was drawn in 4 patients and abnormal in 3. Complications of autonomic failure in these patients resulted in prolonged and recurrent hospitalizations.

Conclusion

Conclusion:
Autonomic testing confirmed the presence of significant autonomic neuropathy in those tested, and autoantibodies associated with autoimmune autonomic neuropathy were present in 3 of 4 patients tested, suggesting a potential autoimmune cause. Ultimately, the autonomic failure resolved in all patients with established long-term follow-up.