Central Nervous System Complications After Transplantation

Dhar, Rajat; Human, Theresa

doi:10.1016/j.ncl.2011.07.002

Cited by 35 publications

(45 citation statements)

References 115 publications

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“…This is a consequence of effective prophylactic strategies against opportunistic pathogens and a more prudent management for immunosuppression 3 . Headache, low-grade fever and mental status impairment are the most common clinical symptoms caused by opportunistic infections in organ transplant recipients 4,5 . In the early post-transplant period (one to two months), the most common infections are derived from the hospital environment.…”

Section: Central Nervous System Infectionsmentioning

confidence: 99%

“…They occur in 5-10% of transplant patients and are generally indicative of a metabolic or structural brain disorder 29 . The most common causes of seizures are immunosuppressant toxicity (especially associated with OKT3 and cyclosporine), metabolic changes, infections, stroke, and tumors 4,29 . Seizures most frequently occur within the first few weeks after transplant and may be generalized or partial, and are usually tonic-clonic 4 .…”

Section: Seizuresmentioning

confidence: 99%

“…The most common causes of seizures are immunosuppressant toxicity (especially associated with OKT3 and cyclosporine), metabolic changes, infections, stroke, and tumors 4,29 . Seizures most frequently occur within the first few weeks after transplant and may be generalized or partial, and are usually tonic-clonic 4 . Seizures associated with drug toxicity are preceded by subtle mental and behavioral changes and are often transient requiring no treatment other than reduction of toxic drugs.…”

Section: Seizuresmentioning

confidence: 99%

“…Although status epilepticus is rare, the clinical diagnosis may sometimes prove difficult and an EEG should be obtained if the patient remains unresponsive after the seizure. The differential diagnosis of seizures include delirium or non-epileptic movements like myoclonus ( focal or multifocal) and tremors, usually secondary to metabolic or drug-induced derangements 4,29 . Patient evaluation should include MRI, CT scans, measurement of immunosuppressive drug levels, EEG and laboratory tests (sodium, calcium, magnesium and glucose).…”

Section: Seizuresmentioning

confidence: 99%

“…Benzodiazepines are the first-line agents used after the first seizure, and if patients require long-term treatment, other drugs may be selected 4,29 .…”

Section: Seizuresmentioning

confidence: 99%

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Neurological complications of solid organ transplantation

Pedroso

Dutra

Braga‐Neto

et al. 2017

Arq. Neuro-Psiquiatr.

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Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased patient survival and improved quality of life. New surgical techniques and immunosuppressive drugs have been developed to achieve better outcomes. However, the variety of neurological complications following solid organ transplantation is broad and carries prognostic significance. Patients may have involvement of the central or peripheral nervous system due to multiple causes that can vary depending on time of onset after the surgical procedure, the transplanted organ, and the intensity and type of immunosuppressive therapy. Neurological manifestations following solid organ transplantation pose a diagnostic challenge to medical specialists despite extensive investigation. This review aimed to provide a practical approach to help neurologists and clinicians assess and manage solid organ transplant patients presenting with acute or chronic neurological manifestations.Keywords: organ transplantation; neurological manifestations; central nervous system; peripheral nervous system. RESUMO O transplante de órgãos sólidos é um importante avanço no tratamento de doenças crônicas renal, hepática e cardíaca. Esta terapia tem aumentado a sobrevida e melhorado a qualidade de vida dos pacientes. Novas técnicas cirúrgicas e imunossupressores tem sido desenvolvidos para alcançar melhores desfechos. Entretanto, a variedade de complicações neurológicas que acompanham o transplante de órgãos sólidos é ampla, e carrega significado prognóstico. Pacientes podem ter acometimento do sistema nervoso central ou periférico devido a múltiplas causas que podem variar conforme o tempo após a realização da cirurgia, órgão transplantado e grau e tipo de terapia de imunossupressão. Manifestações neurológicas após o transplante de órgãos sólidos representam um desafio diagnóstico para médicos especialistas apesar de extensa investigação. O objetivo desta revisão é oferecer uma abordagem prática para ajudar neurologistas e clínicos a avaliar e manejar pacientes com transplante de órgãos sólidos que se apresentem com manifestações neurológicas agudas ou crônicas.Palavras-chave: transplante de órgãos; manifestações neurológicas; sistema nervoso central; sistema nervoso periférico.

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Section: Central Nervous System Infectionsmentioning

confidence: 99%

Section: Seizuresmentioning

confidence: 99%

Section: Seizuresmentioning

confidence: 99%

Section: Seizuresmentioning

confidence: 99%

“…Benzodiazepines are the first-line agents used after the first seizure, and if patients require long-term treatment, other drugs may be selected 4,29 .…”

Section: Seizuresmentioning

confidence: 99%

See 3 more Smart Citations

Neurological complications of solid organ transplantation

Pedroso

Dutra

Braga‐Neto

et al. 2017

Arq. Neuro-Psiquiatr.

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Standard treatment–refractory cytomegalovirus encephalitis unmasked by immune reconstitution inflammatory syndrome and successfully treated with virus‐specific hyperimmune globulin

et al. 2020

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Objectives Cytomegalovirus (CMV)‐related encephalitis is a rare but potentially life‐threatening complication of CMV infection in immunocompromised patients. The high mortality rate is associated with deficient immune system reconstitution after hematopoietic stem cell transplant (HSCT) and poor bioavailability of antiviral drugs in cerebrospinal fluid (CSF). CMV‐related central nervous system (CNS) infection may occur with aspecific symptoms, without evidence of either blood viral load or magnetic resonance imaging (MRI) signs of encephalitis. Methods Here, we describe a 10‐year‐old girl who underwent an allogeneic HSCT and subsequently developed CMV encephalitis. Because of the absence of CMV antigen in the blood, the diagnosis of encephalitis was proposed only after a delay, following the onset of immune reconstitution inflammatory syndrome (IRIS). Two months of combined dual antiviral therapy with ganciclovir and foscarnet proved ineffective against CMV and caused significant bone marrow and renal toxicity. To avoid further toxicity, the girl was given daily treatment with CMV‐hyperimmune globulins alone. Results After three weeks, the CSF viral load dropped significantly and was undetectable within three more weeks. In the meantime, the renal impairment resolved, and there was a complete bone marrow recovery. Conclusion We suggest that this patient succeeded in achieving CMV CSF clearance with high dose of CMV‐hyperimmune globulin, given alone, because of the ability of immunoglobulins to penetrate the blood–brain barrier (BBB).

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Hemichoreo‐hemibalism as a Manifestation of Central Nervous System Chronic Graft‐versus‐Host Disease

Enríquez-Marulanda

Sierra‐Ruiz

Jaramillo

et al. 2017

Movement Disord Clin Pract

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Hematopoietic stem cell transplantation (HSCT) is an effective treatment modality for many life-threatening diseases that were once considered incurable. 1,2 This therapy has evolved rapidly during the last few decades due to immunologic advances and progress in stem cell technology; currently, more than 60,000 HSCTs are carried out annually worldwide. 2 In the first few years of using this therapy, patients survived only for a few months, despite successful grafts and remissions of the malignancies, due to complications that arose soon after transplantation, including severe bleeding or severe infections caused by thrombocytopenia or neutropenia, respectively. 2 Recently, transplantation-related mortality soon after transplantation decreased because of the introduction of reducedintensity conditioning regimens and more effective anti-infectious agents. 3,4 Unfortunately, complications arising a longer period after transplantation, such as graft-versus-host disease (GVHD), has begun to emerge. These are even more problematic than early onset complications, because poor progress has been made in decreasing late transplantation-related mortalities. 3 Here, we report a case of chronic GVHD (cGVHD) of the central nervous system (CNS) presenting as hemichorea-hemiballismus. Case ReportA 45-year-old woman with acute myelogenous leukemia underwent total body irradiation (13.2 Gy) and chemotherapy while awaiting an HLA-haploidentical (5 of 10 compatible alleles) HSCT from her daughter. The transplant was performed with no complications, and she continued post-transplantation cyclophosphamide and fludarabine to facilitate a successful graft. At 104 days post-transplantation, the patient presented with a red and itchy eye and jaundice but no skin rash or diarrhea. She was diagnosed with ocular and hepatic GVHD Type 1; methylprednisolone was initiated, and she achieved complete remission.The patient continued immunosuppressant therapy with prednisolone, and the dose was tapered until Day 219 posttransplantation, at which point the hematologist decided to suspend it, because there was no recurrence of GVHD, and the probability of a later recurrence was low.On Day 253 post-transplantation, the patient was admitted to the emergency room with new-onset, right, involuntary, choreic movements in the distal upper limb associated with flailing and ballistic movements of the right side of the body with no other symptoms (Video S1). A brain magnetic resonance image (MRI) was obtained and, on a fluid-attenuated inversion recovery (FLAIR) sequence, revealed a focal lesion in the right occipital lobe and a lesion in the left globus pallidus. The imaging study did not show any evidence of subthalamic compromise (Fig. 1A, B). Cerebrospinal fluid (CSF) analysis was normal (0 leukocytes; 0 red blood cells; glucose. 50 mg/dL; proteins, 35 mg/dL; Indian ink, potassium hydroxide, Gram, and latex for capsular antigens were negative). Haloperidol and clonazepam were initiated with improvement of symptoms, and the patient was discharged.Fifteen ...

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Central Nervous System Complications After Transplantation

Cited by 35 publications

References 115 publications

Neurological complications of solid organ transplantation

Neurological complications of solid organ transplantation

Standard treatment–refractory cytomegalovirus encephalitis unmasked by immune reconstitution inflammatory syndrome and successfully treated with virus‐specific hyperimmune globulin

Hemichoreo‐hemibalism as a Manifestation of Central Nervous System Chronic Graft‐versus‐Host Disease

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