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Semin Neurol 2015; 35(06): 699-707
DOI: 10.1055/s-0035-1564683
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inpatient Neurologic Consultation in Solid Organ Transplant Patients

Maulik Shah
1   Department of Neurology, University of California San Francisco Medical Center, San Francisco, California
› Author Affiliations
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Publication History

Publication Date:
23 November 2015 (online)

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Abstract

A third of solid organ transplant recipients experience neurologic complications after transplantation. In this article the author reviews common and uncommon complications of the perioperative period including stroke and peripheral neuropathy, neurotoxicity associated with immunosuppressant medications such as calcineurin inhibitors, and opportunistic infections that target the nervous system. A careful clinical history, neurologic examination, and medication review are vital in generating a differential diagnosis that will guide diagnostic testing and decisions regarding treatment and management, and early recognition of many disorders is imperative to prevent irreversible neurologic morbidity and death.

Keywords

transplant medicine - encephalopathy - posterior reversible encephalopathy syndrome - calcineurin inhibitor toxicity - opportunistic infections
 

  • References

  • 1 Organ Procurement and Transplantation Network. Available at: http://optn.transplant.hrsa.gov /converge/latestData/rptData.asp . Accessed June 15, 2015
    PubMedGoogle Scholar
  • 2 Senzolo M, Ferronato C, Burra P. Neurologic complications after solid organ transplantation. Transpl Int 2009; 22 (3) 269-278
    CrossrefPubMedGoogle Scholar
  • 3 Jarquin-Valdivia AA, Wijdicks EFM, McGregor C. Neurologic complications following heart transplantation in the modern era: decreased incidence, but postoperative stroke remains prevalent. Transplant Proc 1999; 31 (5) 2161-2162
    CrossrefPubMedGoogle Scholar
  • 4 Belvís R, Martí-Fàbregas J, Cocho D , et al. Cerebrovascular disease as a complication of cardiac transplantation. Cerebrovasc Dis 2005; 19 (4) 267-271
    CrossrefPubMedGoogle Scholar
  • 5 Zierer A, Melby SJ, Voeller RK , et al. Significance of neurologic complications in the modern era of cardiac transplantation. Ann Thorac Surg 2007; 83 (5) 1684-1690
    CrossrefPubMedGoogle Scholar
  • 6 van de Beek D, Kremers W, Daly RC , et al. Effect of neurologic complications on outcome after heart transplant. Arch Neurol 2008; 65 (2) 226-231
    PubMedGoogle Scholar
  • 7 Muñoz P, Valerio M, Palomo J , et al. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore) 2010; 89 (3) 166-175
    CrossrefPubMedGoogle Scholar
  • 8 Lund LH, Edwards LB, Kucheryavaya AY , et al; International Society of Heart and Lung Transplantation. The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report—2014; focus theme: retransplantation. J Heart Lung Transplant 2014; 33 (10) 996-1008
    CrossrefPubMedGoogle Scholar
  • 9 Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D, Wijdicks EFM. Neurological complications following adult lung transplantation. Am J Transplant 2010; 10 (4) 908-914
    CrossrefPubMedGoogle Scholar
  • 10 Shigemura N, Sclabassi RJ, Bhama JK , et al. Early major neurologic complications after lung transplantation: incidence, risk factors, and outcome. Transplantation 2013; 95 (6) 866-871
    CrossrefPubMedGoogle Scholar
  • 11 Aull-Watschinger S, Konstantin H, Demetriou D , et al. Pre-transplant predictors of cerebrovascular events after kidney transplantation. Nephrol Dial Transplant 2008; 23 (4) 1429-1435
    PubMedGoogle Scholar
  • 12 Colombari RC, de Ataíde EC, Udo EY, Falcão ALE, Martins LC, Boin IFSF. Neurological complications prevalence and long-term survival after liver transplantation. Transplant Proc 2013; 45 (3) 1126-1129
    CrossrefPubMedGoogle Scholar
  • 13 Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995; 333 (24) 1581-1587
    CrossrefPubMedGoogle Scholar
  • 14 Chalela JA, Katzan I, Liebeskind DS , et al. Safety of intra-arterial thrombolysis in the postoperative period. Stroke 2001; 32 (6) 1365-1369
    CrossrefPubMedGoogle Scholar
  • 15 Ahmari SAL, Bunch TJ, Chandra A , et al. Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter. J Heart Lung Transplant 2006; 25 (1) 53-60
    CrossrefPubMedGoogle Scholar
  • 16 Gialdini G, Nearing K, Bhave PD , et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA 2014; 312 (6) 616-622
    CrossrefPubMedGoogle Scholar
  • 17 Saner FH, Sotiropoulos GC, Gu Y , et al. Severe neurological events following liver transplantation. Arch Med Res 2007; 38 (1) 75-79
    CrossrefPubMedGoogle Scholar
  • 18 Zivković SA. Neurologic complications after liver transplantation. World J Hepatol 2013; 5 (8) 409-416
    CrossrefPubMedGoogle Scholar
  • 19 Bernhardt M, Pflugrad H, Goldbecker A , et al. Central nervous system complications after liver transplantation: common but mostly transient phenomena. Liver Transpl 2015; 21 (2) 224-232
    CrossrefPubMedGoogle Scholar
  • 20 Wijdicks EFM, Hocker SE. Neurologic complications of liver transplantation. Handb Clin Neurol 2014; 121: 1257-1266
    PubMedGoogle Scholar
  • 21 Navarro V, Varnous S, Galanaud D , et al. Incidence and risk factors for seizures after heart transplantation. J Neurol 2010; 257 (4) 563-568
    CrossrefPubMedGoogle Scholar
  • 22 Hinchey J, Chaves C, Appignani B , et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334 (8) 494-500
    CrossrefPubMedGoogle Scholar
  • 23 Burnett MM, Hess CP, Roberts JP, Bass NM, Douglas VC, Josephson SA. Presentation of reversible posterior leukoencephalopathy syndrome in patients on calcineurin inhibitors. Clin Neurol Neurosurg 2010; 112 (10) 886-891
    CrossrefPubMedGoogle Scholar
  • 24 Arimura FE, Camargo PCLB, Costa AN , et al. Posterior reversible encephalopathy syndrome in lung transplantation: 5 case reports. Transplant Proc 2014; 46 (6) 1845-1848
    CrossrefPubMedGoogle Scholar
  • 25 Bartynski WS, Tan HP, Boardman JF, Shapiro R, Marsh JW. Posterior reversible encephalopathy syndrome after solid organ transplantation. AJNR Am J Neuroradiol 2008; 29 (5) 924-930
    CrossrefPubMedGoogle Scholar
  • 26 Qin W, Tan CY, Huang X, Huang Z, Tao Y, Fu P. Rapamycin-induced posterior reversible encephalopathy in a kidney transplantation patient. Int Urol Nephrol 2011; 43 (3) 913-916
    CrossrefPubMedGoogle Scholar
  • 27 van de Beek D, Kremers WK, Kushwaha SS, McGregor CG, Wijdicks EF. No major neurologic complications with sirolimus use in heart transplant recipients. Mayo Clin Proc 2009; 84 (4) 330-332
    CrossrefPubMedGoogle Scholar
  • 28 Yamaguchi I, Ichikawa T, Nakao K , et al. Cerebellar ataxia in a patient receiving calcineurin inhibitors after living donor liver transplantation: a case report. Transplant Proc 2007; 39 (10) 3495-3497
    CrossrefPubMedGoogle Scholar
  • 29 Kaczmarek I, Schmauss D, Sodian R , et al. Late-onset tacrolimus-associated cerebellar atrophia in a heart transplant recipient. J Heart Lung Transplant 2007; 26 (1) 89-92
    CrossrefPubMedGoogle Scholar
  • 30 Sierra-Hidalgo F, Martínez-Salio A, Moreno-García S, de Pablo-Fernández E, Correas-Callero E, Ruiz-Morales J. Akinetic mutism induced by tacrolimus. Clin Neuropharmacol 2009; 32 (5) 293-294
    CrossrefPubMedGoogle Scholar
  • 31 Venneti S, Moss HE, Levin MH , et al. Asymmetric bilateral demyelinating optic neuropathy from tacrolimus toxicity. J Neurol Sci 2011; 301 (1–2) 112-115
    CrossrefPubMedGoogle Scholar
  • 32 Fukazawa K, Nishida S, Aguina L, Pretto Jr E. Central pontine myelinolysis (CPM) associated with tacrolimus (FK506) after liver transplantation. Ann Transplant 2011; 16 (3) 139-142
    CrossrefPubMedGoogle Scholar
  • 33 DiMartini A, Fontes P, Dew MA, Lotrich FE, de Vera M. Age, model for end-stage liver disease score, and organ functioning predict posttransplant tacrolimus neurotoxicity. Liver Transpl 2008; 14 (6) 815-822
    CrossrefPubMedGoogle Scholar
  • 34 Hayes Jr D, Adler B, Turner TL, Mansour HM. Alternative tacrolimus and sirolimus regimen associated with rapid resolution of posterior reversible encephalopathy syndrome after lung transplantation. Pediatr Neurol 2014; 50 (3) 272-275
    CrossrefPubMedGoogle Scholar
  • 35 Echaniz-Laguna A, de Séze J, Chanson J-B. Chronic inflammatory demyelinating polyradiculoneuropathy in solid organ transplant recipients: a prospective study. J Neurol Neurosurg Psychiatry 2012; 83 (7) 699-705
    CrossrefPubMedGoogle Scholar
  • 36 Bhagavati S, Maccabee P, Muntean E, Sumrani NB. Chronic sensorimotor polyneuropathy associated with tacrolimus immunosuppression in renal transplant patients: case reports. Transplant Proc 2007; 39 (10) 3465-3467
    CrossrefPubMedGoogle Scholar
  • 37 Labate A, Morelli M, Palamara G, Pirritano D, Quattrone A. Tacrolimus-induced polyneuropathy after heart transplantation. Clin Neuropharmacol 2010; 33 (3) 161-162
    CrossrefPubMedGoogle Scholar
  • 38 Pfitzmann R, Klupp J, Langrehr JM , et al. Mycophenolatemofetil for immunosuppression after liver transplantation: a follow-up study of 191 patients. Transplantation 2003; 76 (1) 130-136
    CrossrefPubMedGoogle Scholar
  • 39 Martin MA, Massanari RM, Nghiem DD, Smith JL, Corry RJ. Nosocomial aseptic meningitis associated with administration of OKT3. JAMA 1988; 259 (13) 2002-2005
    CrossrefPubMedGoogle Scholar
  • 40 Zonios DI, Gea-Banacloche J, Childs R, Bennett JE. Hallucinations during voriconazole therapy. Clin Infect Dis 2008; 47 (1) e7-e10
    CrossrefPubMedGoogle Scholar
  • 41 Muller MP, Richardson DC, Walmsley SL. Trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant patient. Clin Nephrol 2001; 55 (1) 80-84
    PubMedGoogle Scholar
  • 42 Koller WC, Gehlmann LK, Malkinson FD, Davis FA. Dapsone-induced peripheral neuropathy. Arch Neurol 1977; 34 (10) 644-646
    CrossrefPubMedGoogle Scholar
  • 43 Hall WA, Martinez AJ, Dummer JS , et al. Central nervous system infections in heart and heart-lung transplant recipients. Arch Neurol 1989; 46 (2) 173-177
    CrossrefPubMedGoogle Scholar
  • 44 van de Beek D, Patel R, Daly RC, McGregor CGA, Wijdicks EFM. Central nervous system infections in heart transplant recipients. Arch Neurol 2007; 64 (12) 1715-1720
    CrossrefPubMedGoogle Scholar
  • 45 Peleg AY, Husain S, Qureshi ZA , 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) 1307-1314
    CrossrefPubMedGoogle Scholar
  • 46 Mamelak AN, Obana WG, Flaherty JF, Rosenblum ML. Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery 1994; 35 (4) 622-631
    CrossrefPubMedGoogle Scholar
  • 47 Mizuno S, Zendejas IR, Reed AI , et al. Listeria monocytogenes following orthotopic liver transplantation: central nervous system involvement and review of the literature. World J Gastroenterol 2007; 13 (32) 4391-4393
    CrossrefPubMedGoogle Scholar
  • 48 Boon AP, Adams DH, Buckels J, McMaster P. Cerebral aspergillosis in liver transplantation. J Clin Pathol 1990; 43 (2) 114-118
    CrossrefPubMedGoogle Scholar
  • 49 Wu G, Vilchez RA, Eidelman B, Fung J, Kormos R, Kusne S. Cryptococcal meningitis: an analysis among 5,521 consecutive organ transplant recipients. Transpl Infect Dis 2002; 4 (4) 183-188
    CrossrefPubMedGoogle Scholar
  • 50 Singh N, Alexander BD, Lortholary O , et al; Cryptococcal Collaborative Transplant Study Group. Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality. J Infect Dis 2007; 195 (5) 756-764
    CrossrefPubMedGoogle Scholar
  • 51 Fernàndez-Sabé N, Cervera C, Fariñas MC , et al. Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study. Clin Infect Dis 2012; 54 (3) 355-361
    CrossrefPubMedGoogle Scholar
  • 52 Bodro M, Sabé N, Santín M , et al. Clinical features and outcomes of tuberculosis in solid organ transplant recipients. Transplant Proc 2012; 44 (9) 2686-2689
    CrossrefPubMedGoogle Scholar
  • 53 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) 915-926
    CrossrefPubMedGoogle Scholar
  • 54 El-Sabrout RA, Radovancevic B, Ankoma-Sey V, Van Buren CT. Guillain-Barré syndrome after solid organ transplantation. Transplantation 2001; 71 (9) 1311-1316
    CrossrefPubMedGoogle Scholar
  • 55 Seeley WW, Marty FM, Holmes TM , et al. Post-transplant acute limbic encephalitis: clinical features and relationship to HHV6. Neurology 2007; 69 (2) 156-165
    CrossrefPubMedGoogle Scholar
  • 56 Verhelst X, Vanhooren G, Vanopdenbosch L , et al. Progressive multifocal leukoencephalopathy in liver transplant recipients: a case report and review of the literature. Transpl Int 2011; 24 (4) e30-e34
    CrossrefPubMedGoogle Scholar
  • 57 Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf . Accessed July 15, 2015
    PubMedGoogle Scholar
  • 58 Winston DJ, Vikram HR, Rabe IB , et al; West Nile Virus Transplant-Associated Transmission Investigation Team. Donor-derived West Nile virus infection in solid organ transplant recipients: report of four additional cases and review of clinical, diagnostic, and therapeutic features. Transplantation 2014; 97 (9) 881-889
    CrossrefPubMedGoogle Scholar
  • 59 Penn I, Porat G. Central nervous system lymphomas in organ allograft recipients. Transplantation 1995; 59 (2) 240-244
    CrossrefPubMedGoogle Scholar
  • 60 Cavaliere R, Petroni G, Lopes MB, Schiff D ; International Primary Central Nervous System Lymphoma Collaborative Group. Primary central nervous system post-transplantation lymphoproliferative disorder: an international primary central nervous system lymphoma collaborative group report. Cancer 2010; 116 (4) 863-870
    CrossrefPubMedGoogle Scholar
  • 61 Lake W, Chang JE, Kennedy T, Morgan A, Salamat S, Başkaya MK. A case series of primary central nervous system posttransplantation lymphoproliferative disorder: imaging and clinical characteristics. Neurosurgery 2013; 72 (6) 960-970 , discussion 970
    CrossrefPubMedGoogle Scholar