AUTHOR=Nedkova-Hristova Velina , Baliellas Carmen , González-Costello José , Lladó Laura , González-Vilatarsana Emma , Vélez-Santamaría Valentina , Casasnovas Carlos 

TITLE=Treatment With Diflunisal in Domino Liver Transplant Recipients With Acquired Amyloid Neuropathy

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10454

DOI=10.3389/ti.2022.10454

ISSN=1432-2277

ABSTRACT=Objectives: To analyze the efficacy and tolerability of diflunisal for the treatment of acquired amyloid neuropathy in domino liver transplant recipients.
Methods: We performed a retrospective longitudinal study of prospectively collected data for all domino liver transplant recipients with acquired amyloid neuropathy who received diflunisal at our hospital. Neurological deterioration was defined as a score increase of ≥2 points from baseline on the Neurological Impairment Scale/ Neurological Impairment Scale-Lower Limbs.
Results: Twelve patients who had received compassionate use treatment with diflunisal were identified, of whom seven had follow-up data for ≥12 months. Five patients (71.4%) presented with neurological deterioration on the Neurological Impairment Scale after 12 months (p = 0.0382). The main adverse effects were cardiovascular and renal, leading to diflunisal being stopped in five patients and the dose being reduced in two patients.
Conclusions: Our study suggests that most domino liver transplant recipients with acquired amyloid neuropathy will develop neurological deterioration by 12 months of treatment with diflunisal. This therapy was also associated with a high incidence of adverse effects and low treatment retention. The low efficacy and low tolerability of diflunisal treatment encourage the search for new therapeutic options.