Cystic fibrosis patients with and without central nervous system complications following lung transplantation

Abstract

Central nervous system (CNS) complications occur more frequently in cystic fibrosis (CF) patients than other lung transplant recipients. The purpose of this study was to compare CF patients with and without CNS complications following lung transplantation, to identify risk factors for CNS events. Records of 21 patients with CF who underwent lung transplant between 1991–1996 were reviewed. Data were collected on multiple variables, including: age at transplant; gender; cytomegalovirus (CMV) status; cholesterol and triglyceride levels; sinusitis; percent ideal body weight (IBW); body mass index (BMI); augmented immunosuppression, acute lung rejection episodes (ALR); cyclosporine doses; electrolytes; magnesium, blood urea nitrogen (BUN), and creatinine levels; and 6‐month survival. CNS complications identified were seizures, severe headaches (HA), strokes, or confusional episodes. Eleven of 21 patients (52%) with CF had CNS events: eight had seizures, five HA, three strokes, and one confusional episode. There was no difference in age at transplant, pretransplant percent IBW or BMI, cholesterol and triglyceride levels, or number of ALR. CMV mismatch and clinical sinusitis had no effect. Cyclosporine doses did not differ between groups at 30 days, or 3 or 6 months posttransplant. Both BUN and creatinine concentrations showed a rise over time that did not differ between groups. Potassium levels were within normal limits for both groups. While sodium levels did not differ between groups pretransplant, or at 30 days or 6 months posttransplant, a decrease in sodium values was seen at the time of CNS events. There was no difference in 6‐month survival. We could not identify any pre‐ or posttransplant risk factors that predicted CNS events. It is likely that cyclosporine toxicity is the major cause of CNS complications. Despite the high rate of CNS events, the overall prognosis was good, and 6‐month survival was not affected. Pediatr Pulmonol. 2000; 30:203–206. © 2000 Wiley‐Liss, Inc.

Neurologic complications following lung transplantation

“…There was a trend for higher prevalence of seizures and headaches in transplant recipients with CF, but this was not statistically significant (p N 0.05). Similar findings were previously reported with higher prevalence of CNS complications in this population [4,6]. Patients with CF are overall younger, but severe multisystemic pretransplant metabolic disturbances may explain their vulnerability to posttransplant complications.…”

“…In recent years, overall improvement in patient survival shifted the spectrum of post-transplant complications from acute and perioperative events towards subacute and chronic complications. There are only a few reports describing neurologic complications after lung transplantation in adult and pediatric recipients with an increased frequency of neurologic complications reported in recipients with cystic fibrosis [3][4][5][6][7].…”

Influence of early neurological complications on clinical outcome following lung transplant

“…Previous studies have analyzed the frequency of neurological complications, mainly focusing on the CNS or on isolated neurological complications [9,12,13,22,23,25]. This explains why the rate of neurological complications in lung transplantation recipients ranges between 11.5% and 66% [12,13,22,23,25].…”

“…This explains why the rate of neurological complications in lung transplantation recipients ranges between 11.5% and 66% [12,13,22,23,25]. To the best of our knowledge, this is the first time that the entire spectrum of neurological complications after lung transplantation (i.e.…”

“…In lung recipients, serious complications involving the central nervous system (CNS) have been the focus of study to date, and neurological problems affecting the peripheral and autonomic nervous systems have until recently received little attention [21–23]. Although diseases of the peripheral nervous system (PNS) and the autonomic nervous system (ANS) have been reported post-lung transplant, the incidence of clinical characteristics and the impact of the neurological complications in the lung transplant population are generally unknown [13,24–27].…”