Neurological complications in renal transplant patients: A single-center experience

Abstract

AimsTo evaluate the nature and incidence of neurologic complications in recipients of living donor renal transplantation. Neurologic complications are a significant cause of morbidity and mortality in patients who undergo transplants and there is paucity of data regarding the same. The epidemiology of infective agents varies according to geographical locations. MethodsWe included 856 patients of live related renal transplantation at our institution between January 2002 and December 2009. All recipients who were found to have some clinical, laboratory, or radiological evidence of neurological involvement were considered. Associated comorbid medical conditions, presenting neurologic symptoms, and type of immunosuppression were recorded. Occurrence of acute rejections, chronic allograft nephropathy (CAN), delayed graft function, and new onset diabetes after transplant (NODAT) were recorded. ResultsOf the total 856 renal transplant recipients, a total of 93 (10.8%) patients were found to have some clinical, laboratory, or radiological evidence of neurological involvement. A total of 69 (73.3%) developed CNS complications with a mortality rate of 37.7%. CNS infections occurred in 47 (5% of total) recipients and accounted for the largest group (68.1%). Fungi were the commonest etiological agents, 22 (46.8%), and were associated with 40% mortality. Cryptococcal meningitis was occurring in 19 (27.5%), with mortality in 31.6% of these. Other fungal infections were aspergillosis in two and mucormycosis in one. All patients with aspergillosis and mucormycosis had a fatal outcome. The second largest group on CNS complications comprised of patients with cerebrovascular accidents, which occurred in 13 patients (18.8%), and were associated with a mortality of 23%. Eight patients with ischemic stroke had survived. Two had hemorrhagic stroke and both had a fatal outcome. Three patients had subdural hematoma with 33.3% mortality. Four patients had toxic encephalopathy as a result of fulminant systemic sepsis with mortality in all. Other less common CNS complications included intracranial space occupying lesion in two, postoperative psychosis in two, and hypoglycemic coma in one. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. A total 61 (65.5%) patients, which comprises 7% of the total transplant recipients, presented with some complications involving the peripheral nervous system (PNS). The most common manifestations were tremor in 26.5%, followed by paresthesias in 18.3%, steroid-induced myopathy in 11.8%, ulnar neuropathy in 4.4, and femoral neuropathy in 2.2%. These complications were more common with tacrolimus. ConclusionWe conclude that complications involving the neurological system occur in 10.5% of all transplant patients with 8% involving CNS and 7% involving the PNS. The high mortality rates associated with CNS complications warrant early diagnosis and aggressive treatment in renal transplant recipients.