• Users Online: 646
  • Print this page
  • Email this page
ORIGINAL ARTICLE
Year : 2015  |  Volume : 9  |  Issue : 4  |  Page : 130-137

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


Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Science, Rai Barielly Road, Lucknow, Uttar Pradesh 226014, India

Correspondence Address:
Raj Kumar Sharma
Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Science, Rai Barielly Road, Lucknow, Uttar Pradesh 226014
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijt.2015.10.018

Get Permissions

Aims: To 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. Methods: We 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. Results: Of 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. Conclusion: We 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.


[PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed54    
    Printed10    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    
    Cited by others 2    

Recommend this journal