Neurologic complications in kidney transplant recipients

Abstract

<i>Transplantology experiences continuous growth and kidney transplantation is the most frequently transplanted solid organ. Metabolic, cardiovascular, infectious or kidney function-related aspects are widely recognised and are of key interest for transplant doctors. Neurological complications seen in these patients, although known, are less covered in the literature. According to some reports, neurologic symptoms are experienced by almost 9 per 10 transplant recipients. The intensity, severity and type of abnormalities may vary, and most frequently the complications seem to be associated with a direct or indirect effect of immunosuppressive medications, including their direct effect on cells, on blood vessels, and susceptibility to infections. Increasing age of transplant recipients and relaxation of transplantation eligibility criteria enriches the population with patients already compromised, with a higher present risk of stroke, neuropathy, malignancy etc. Research on and introduction to clinical practice of new agents like belatacept, proteasome inhibitors, or modified release formulations of tacrolimus, changes the picture and type of abnormalities within the nervous or neuromuscular system but does not eliminate them. Thus, it seems justified to remind the society of the whole array of neurologic complications they can see in their practice despite advances in the field.</i>.

Severe anorexia and weight loss induced by tacrolimus in kidney transplant recipients

“…However, the exact mechanism of tacrolimus-induced neurotoxicity is not yet well understood. The mechanisms underlying the neurotoxicity of calcineurin inhibitors may be related to up regulation of endothelin receptors A and B and stimulation of endothelin 1 synthesis, damage to the blood–brain barrier, alterations in mitochondrial function, interaction with neuromodulatory systems and vascular toxicity [ 12 , 13 ].…”

The Role of Cardiolipin and Mitochondrial Damage in Kidney Transplant

“…The intensity, severity, and type of anomalies may vary. More often, complications appear to be associated with the direct or indirect effect of immunosuppressants because of their direct effect on cells and blood vessels and susceptibility to infections [132]. However, we found no information in the available literature on the complications of RT related to cardiolipin and its antibodies.…”

Immunosuppression-related neurological disorders in kidney transplantation

“…The risk of developing systemic lymphoma in the first year after renal transplantation has been estimated to be 20 times higher than in the general population [65]. Almost 30% of all post-transplant lymphoproliferative disorders (PTLD) affect the CNS [66] and the most frequent malignant form is represented by large diffuse B-cell lymphoma, which accounts for only 2% of CNS malignancies in the general population. Many PTLD cases result from prior EBV infection, even though CSF and serum analyses might be negative for EBV-DNA and the specific pathogenic mechanism remains unclear [67].…”