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A new side effect of immunosuppression: High incidence of hearing impairment after liver transplantation

Authors

  • Kinan Rifai,

    Corresponding author
    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
    • Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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    • Telephone: 49-511-532-3305; FAX: 49-511-532-4896

  • Gabriele I. Kirchner,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
    Current affiliation:
    1. Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, 93042 Regensburg, Germany
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  • Matthias J. Bahr,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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  • Tobias Cantz,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
    Current affiliation:
    1. Max-Planck-Institut für Molekulare Biomedizin, Bereich Zell- und Entwicklungsbiologie, Mendelstraße 7, 48149 Münster, Germany
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  • Jens Rosenau,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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  • Björn Nashan,

    1. Department of Visceral and Transplant Surgery, Medical School Hannover, Hannover, Germany
    Current affiliation:
    1. Director, Multi-Organ Transplant Program, Departments of Surgery, Medicine, Urology, Microbiology and Immunology, Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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  • Jürgen L. Klempnauer,

    1. Department of Visceral and Transplant Surgery, Medical School Hannover, Hannover, Germany
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  • Michael P. Manns,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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  • Christian P. Strassburg

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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Abstract

Little is known about hearing impairment in patients after organ transplantation. We conducted a single-center study to evaluate hearing impairment in patients after orthotopic liver transplantation (OLT). A questionnaire was sent to 695 adult patients after OLT to assess characteristics and course of auditory impairment. Risk factors such as ototoxic drugs were taken into consideration. Clinical follow-up, including immunosuppressive therapy, was analyzed in detail. The questionnaire was completed by 521 patients (75%). Hearing impairment was reported by 184 patients (35%). A total of 43 patients (8%) suffered from hearing abnormalities prior to OLT. The remaining 141 patients (27%) developed hearing impairment after transplantation. Main problems were hearing loss (52%), tinnitus (38%), and otalgia (30%). There was no association of post-OLT hearing disorders with age or known risk factors. In 43% of patients, onset of hearing impairment was within 2 yr post-OLT. Hearing loss was positively associated with tacrolimus immunosuppression in univariate (P < 0.05) and multivariate analysis (P < 0.02). Patients using a hearing aid received tacrolimus more frequently than cyclosporine (P < 0.05). In conclusion, subjective hearing impairment is frequent in patients after OLT and contributes to post-OLT morbidity. Calcineurin inhibitor-related neurotoxicity appears as a possible mechanism. Further prospective investigations with objective hearing tests are necessary to confirm these results and to evaluate the role of immunosuppression. Liver Transpl, 2006. © 2006 AASLD.

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