Scripties UMCG - Rijksuniversiteit Groningen
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The Prevalence and predictors of Polyneuropathic Signs and Symptoms in a Transplantation Population

(2018) Hofman, J.M.G. (Jesse)

Background: Sensory disturbances are often reported by transplantation patients in the UMCG. Patients with polyneuropathy (PNP) experience significant disability as a result of pain, ulceration, and instability when walking. Calcineurin inhibitors (CNIs) used by organ recipients are known to have an effect on the nervous system, and may therefore be responsible for these complaints. Furthermore, it is known that organ recipients are weaker than age-matched healthy controls. It is possible that this weakness is a result of PNP.
Aim: To describe the prevalence of polyneuropathic signs and symptoms in organ recipients and healthy controls and to determine whether the prevalence in recipients can be attributed to CNI use. Furthermore, to describe muscle strength in organ recipients and healthy controls and to examine whether muscle strength is associated with the PNP score and distally more pronounced compared to proximal.
Methods: Data from the TransplantLines Biobank and Cohort study were used for this study. An adapted version of the modified Toronto Clinical Neuropathy Score (amTCNS) was used to quantify neurological complaints and to score sensory symptoms. A hand-held dynamometer was used to measure the strength of different muscle groups. Medication and lab data were extracted from the patients’ medical files. A Chi-square test was used to test the difference in the donors and recipients who had an amTCNS of >5. Linear regressions were used to assess the influence of CNIs on amTCNS and the association between amTCNS and muscle strength.
Results: The amTCNS was >5 in 3.0% of donors and in 19.8% of recipients. In the non-diabetic subgroup, these numbers were 3.0% and 15.9% (p<0.001) respectively. In univariable linear regression, CNI use was not a significant predictor of amTCNS (b -0.62, p=0.392). Muscle strength was lower in all tests except for hand-grip strength. In multivariable linear regression, amTCNS was a significant predictor of muscle strength, however, its predictive value was less in the foot flexors, a distal muscle (β -.13, p=0.046) than in the elbow flexors, a proximal muscle (β -.20, p<0.001).
Conclusion: According to both anamnestic evaluation and sensory testing, polyneuropathic signs and symptoms are more common in organ receivers than in healthy controls, and CNIs are not responsible for this difference. Muscle strength is reduced in receivers compared to healthy controls, and this difference is the result of generalized weakness rather than PNP.

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