Neurological complications of solid organ transplantation

José Luiz Pedroso; Lívia Almeida Dutra; Pedro Braga-Neto; Agessandro Abrahao; João Brainer Clares de Andrade; Gabriel Lopes da Silva; Laila Almeida Viana; José Osmar Medina Pestana; Orlando G. Barsottini

doi:10.1590/0004-282X20170132

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(10): 736-747
DOI: 10.1590/0004-282X20170132

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Neurological complications of solid organ transplantation

Complicações neurológicas no transplante de órgãos sólidos

Authors

José Luiz Pedroso

¹Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brasil;
Lívia Almeida Dutra

¹Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brasil;
Pedro Braga-Neto

²Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE, Brasil;

³Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Clínica Médica, Fortaleza, CE, Brasil;
Agessandro Abrahao

¹Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brasil;
João Brainer Clares de Andrade

¹Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brasil;
Gabriel Lopes da Silva

¹Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brasil;
Laila Almeida Viana

⁴Universidade Federal de São Paulo, Departamento de Nefrologia, São Paulo SP, Brasil.
José Osmar Medina Pestana

⁴Universidade Federal de São Paulo, Departamento de Nefrologia, São Paulo SP, Brasil.
Orlando G. Barsottini

¹Universidade Federal de São Paulo, Divisão de Neurologia Geral, Departamento de Neurologia, São Paulo SP, Brasil;

Abstract

ABSTRACT

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.

RESUMO

O transplante de órgãos sólidos é um importante avanço no tratamento de doenças crçnicas 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 crçnicas.

Keywords:

organ transplantation - neurological manifestations - central nervous system - peripheral nervous system

Palavras-chave:

transplante de órgãos - manifestações neurológicas - sistema nervoso central - sistema nervoso periférico

Full Text

References

References
1 Lewis MB, Howdle PD. Neurologic complications of liver transplantation in adults. Neurology. 2003;61(9):1174-8. https://doi.org/10.1212/01.WNL.0000089487.42870.C6
2 Zivković SA, Abdel-Hamid H. Neurologic manifestations of transplant complications. Neurol Clin. 2010;28(1):235-51. https://doi.org/10.1016/j.ncl.2009.09.011
3 Singh N, Husain S. Infections of the central nervous system in transplant recipients. Transpl Infect Dis. 2000;2(3):101-11. https://doi.org/10.1034/j.1399-3062.2000.020302.xPMID:11429020
4 Dhar R, Human T. Central nervous system complications after transplantation. Neurol Clin. 2011;29(4):943-72. https://doi.org/10.1016/j.ncl.2011.07.002
5 Beek D, Patel R, Daly RC, McGregor CG, Wijdicks EF. Central nervous system infections in heart transplant recipients. Arch Neurol. 2007;64(12):1715-20. https://doi.org/10.1001/archneur.64.12.noc70065
6 Fishman JA, Issa NC. Infection in organ transplantation: risk factors and evolving patterns of infection. Infect Dis Clin North Am. 2010;24(2):273-83. https://doi.org/10.1016/j.idc.2010.01.005
7 Subramanian AK, Morris MI. Practice TIDCo. Mycobacterium tuberculosis infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):68-76. https://doi.org/10.1111/ajt.12100
8 Clauss HE, Lorber B. Central nervous system infection with Listeria monocytogenes. Curr Infect Dis Rep. 2008;10(4):300-6. https://doi.org/10.1007/s11908-008-0049-0
9 Peleg AY, Husain S, Qureshi ZA, Silveira FP, Sarumi M, Shutt KA et al. Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study. Clin Infect Dis. 2007;44(10):1307-14. https://doi.org/10.1086/514340
10 Cohen BA, Stosor V. Opportunistic Infections of the Central Nervous System in the Transplant Patient. Curr Neurol Neurosci Rep. 2013;13(9):376. https://doi.org/10.1007/s11910-013-0376-x
11 Shintaku M, Kaneda D, Tada K, Katano H, Sata T. Human herpes virus 6 encephalomyelitis after bone marrow transplantation: report of an autopsy case. Neuropathology. 2010;30(1):50-5. https://doi.org/10.1111/j.1440-1789.2009.01020.X
12 Ward KN, White RP, Mackinnon S, Hanna M. Human herpesvirus-7 infection of the CNS with acute myelitis in an adult bone marrow recipient. Bone Marrow Transplant. 2002;30(12):983-5. https://doi.org/10.1038/sj.bmt.1703774
13 Reddy SM, Winston DJ, Territo MC, Schiller GJ. CMV central nervous system disease in stem-cell transplant recipients: an increasing complication of drug-resistant CMV infection and protracted immunodeficiency. Bone Marrow Transplant. 2010;45(6):979-84. https://doi.org/10.1038/bmt.2010.35
14 Gourishankar S, McDermid JC, Jhangri GS, Preiksaitis JK. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era. Am J Transplant. 2004;4(1):108-15. https://doi.org/10.1046/j.1600-6143.2003.00287.x
15 Kittan NA, Beier F, Kurz K, Niller HH, Egger L, Jilg W et al. Isolated cerebral manifestation of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder after allogeneic hematopoietic stem cell transplantation: a case of clinical and diagnostic challenges. Transpl Infect Dis. 2011;13(5):524-30. https://doi.org/10.111/j.1399-3062.2011.00621.x
16 Romee R, Brunstein CG, Weisdorf DJ, Majhail NS. Herpes simplex virus encephalitis after allogeneic transplantation: an instructive case. Bone Marrow Transplant. 2010;45(4):776-8. https://doi.org/10.1038/bmt.2009.208
17 Mateen FJ, Muralidharan R, Carone M, Beek D, Harrison DM, Aksamit AJ et al. Progressive multifocal leukoencephalopathy in transplant recipients. Ann Neurol. 2011;70(2):305-22. https://doi.org/10.1002/ana.22408
18 Clark NM, Reid GE. Nocardia infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):83-92. https://doi.org/10.1111/ajt.12102
19 Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J. Community-acquired Listeria monocytogenes meningitis in adults. Clin Infect Dis. 2006;43:1233-8. https://doi.org/10.1086/508462
20 Nelson CA, Zunt JR. Tuberculosis of the central nervous system in immunocompromised patients: HIV infection and solid organ transplant recipients. Clin Infect Dis. 2011;53(9):915-26. https://doi.org/10.1093/cid/cir508
21 Singh N, Husain S. Aspergillosis in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):228-41. https://doi.org/10.1111/ajt.12115
22 Lanternier F, Sun HY, Ribaud P, Singh N, Kontoyiannis DP, Lortholary O. Mucormycosis in organ and stem cell transplant recipients. Clin Infect Dis. 2012;54(11):1629-36. https://doi.org/10.1093/cid/cis195
23 Sun HY, Wagener MM, Singh N. Cryptococcosis in solid-organ, hematopoietic stem cell, and tissue transplant recipients: evidence-based evolving trends. Clin Infect Dis. 2009;48(11):1566-76. https://doi.org/10.1086/598936
24 Schwartz BS, Mawhorter SD. Practice TIDCo: Parasitic infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):280-303. https://doi.org/10.1111/ajt.12120
25 Bhagavati S, Maccabee P Muntean E,et al. Chronic sensorimotor polyneuropathy associated with tacrolimus immunosuppression in renal transplant patients: case reports. Transplant Proc. 2007;39(10):3465-7. https://doi.org/10.1016/j.transproceed.2007.06.088
26 El-Sabrout RA, Radovancevic B, Ankoma-Sey V, Van Buren CT. Guillain-Barré syndrome after solid organ transplantation. Transplantation. 2001;71(9):1311-6. https://doi.org/10.1097/00007890-200105150-00023
27 Echaniz-Laguna A, Seze J, Chanson JB. Chronic inflammatory demyelinating polyradiculoneuropathy in solid organ transplant recipients: a prospective study. J Neurol Neurosurgery Psychiatry. 2012;83(7):699-705. https://doi.org/10.1136/jnnp-2012-302374
28 De Jonghe B, Lacherade JC, Durand MC, Sharshar T. Critical illness neuromuscular syndromes. Neurol Clin. 2008;26(2):507-20. https://doi.org/10.1016/j.ncl.2008.03.001
29 Gilmore RL. Seizures and antiepileptic drug use in transplant patients. Neurol Clin. 1988;6(2):279-96.
30 Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914-25. https://doi.org/10.1016/S1474-4422(15)00111-8
31 Pustavoitau A, Bhardwaj A, Stevens R. Neurological complications of transplantation. J Intensive Care Med. 2011;26(4):209-22. https://doi.org/10.1177/0885066610389549
32 Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146(1):34-44. https://doi.org/10.7326/0003-4819-146-1-200701020-00007
33 Surman OS, Cosimi AB, DiMartini A. Psychiatric care of patients undergoing organ transplantation. Transplantation. 2009;87(12):1753-61. https://doi.org/10.1097/TP.0b013e3181a754d4
34 Abbott KC, Agodoa LY, O’Malley PG. Hospitalized psychoses after renal transplantation in the United States: incidence, risk factors, and prognosis. J Am Soc Nephrol. 2003;14(6):1628-35. https://doi.org/10.1097/01.ASN.0000069268.63375.4A
35 Dew MA, DiMartini AF, Steel J, De Vito Dabbs A, Myaskovsky L, Unruh M et al. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl. 2008;14(2):159-72. https://doi.org/10.1002/lt.21278
36 Honda M, Koga M, Kanda T. [Primary central nervous system post-transplant lymphoproliferative disorders]. Brain Nerve. 2014;66(8):947-54. Portuguese.
37 Dougan C, Ormerod I. A neurologist's approach to the immunosuppressed patient. J Neurol Neurosurg Psychiatry. 2004;75(Suppl 1):i43-9. https://doi.org/10.1136/jnnp.2003.035071
38 Pustavoitau A, Bhardwaj A, Stevens R. Neurological complications of transplantation. J Intensive Care Med. 2011;26(4):209-22. https://doi.org/10.1177/0885066610389549
39 Deutsch ES, Bartling V, Lawenda B, Schwegler J, Falkenstein K, Dunn S. Sensorineural hearing loss in children after liver transplantation. Arch Otolaryngol Head Neck Surg. 1998;124(5): 529-33. https://doi.org/10.1001/archotol.124.5.529