Neurologic complications with renal transplantation

Neurologic complications with renal transplantation

What neurologic complications are associated with renal transplantation? 

Neurologic complications of renal transplantation can be due to either the renal disease necessitating transplantation or posttransplantation immunosuppression.

Calcineurin inhibitors are the most common immunosuppressive medications in renal transplant patients and may cause tremors, paresthesia, a severe disabling pain syndrome, and posterior reversible encephalopathy syndrome. Reduction or discontinuation of the drug can either reverse or reduce the majority of the neurologic side effects.

The monoclonal antibody OKT3 may induce severe neurologic syndromes such as aseptic meningitis.

Stroke occurs in about 8% of renal transplant patients. End-stage renal disease due to diabetes and/or peripheral vascular disease are the strongest risk factors.

Guillain–Barré syndrome may also develop, triggered in some cases by either cytomegalovirus or Campylobacter jejuni infection. Infection represents the most frequent neurologic complication in transplant patients on immunosuppression.

Acute meningitis, usually caused by Listeria monocytogenes , and subacute and chronic meningitis, caused by Cryptococcus neoformans , account for more than 90% of nonviral CNS infections. Aspergillus fumigatus , Toxoplasma gondii , and Nocardia asteroides result in focal brain infection and JC virus, a polyoma virus, and cause progressive multifocal leukoencephalopathy.

Lymphomas are the most frequent brain tumors.

They are usually associated with an Epstein–Barr virus infection and are more frequent in patients who receive aggressive immunosuppressive therapy.

The overall risk of developing cancer following renal transplantation is approximately 6%, or about 100-fold greater than that expected for the general nonimmunosuppressed population. 

Sources

  • Zepeda-Orozco D, Quigley R: Dialysis disequilibrium syndrome. Pediatr Nephrol 27(12):2205-2211, 2012. 
  • Mudge DW, Johnson DW, Hawley CM, Campbell SB, Isbel NM, Van Eps CL, et al.: Do aluminum-based phosphate binders continue to have a role in contemporary nephrology practice? BMC Nephrol 12:20, 2011. 
  • Amato AA, Barohn RJ: Transplantation and immunosuppressive medication. In Rolak LA, Harati Y (eds): Neuro-immunology for the clinician. Boston, Butterworth-Heinemann, pp 341-376, 1997. 
  • Ponticelli C, Campise MR: Neurological complications in kidney transplant recipients. J Nephrol 18:521-528, 2005. 
  • Potluri K, Holt D, Hou S: Neurologic complications in renal transplantation. Handb Clin Neurol 121:1245-1255, 2014.
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