Guillain‐Barré syndrome post renal transplant: A systematic review

Abstract

Background Guillain‐Barré syndrome (GBS) is a common ascending polyneuropathy in adults. It is often associated with preceding viral or diarrhoeal illness with cytomegalovirus (CMV), Epstein‐Barr virus (EBV), or Campylobacter jejuni. Solid organ transplant recipients are more susceptible to opportunistic infections with CMV than the general population as a result of immunosuppressive therapies to prevent graft rejection. However, reports of GBS are rare in this population. Objective To systematically review cases of GBS in renal transplant patients to evaluate causative pathogens or triggers, management and associated morbidity and mortality. Methods and results We conducted a systematic search of the MEDLINE database uncovering 17 cases of GBS in renal transplant patients in the literature. The majority of cases were in males (81%) and patients who received deceased donor renal transplants (87%). The mean age was 44.7 years (SD 13). The time between transplant and onset of symptoms ranged from 2 days to 10 years (Mean = 720 days). GBS was commonly associated with antecedent viral (CMV 12; EBV 1) or diarrhoeal (2) illness while two cases were attributed to calcineurin inhibitor use. All patients recovered fully or partially after treatment with anti‐viral or anti‐bacterial agents, immunoglobulins, and/or plasma exchange. Conclusion Cytomegalovirus is the most common trigger for GBS in the post‐renal transplant setting. Other triggers include campylobacter jejuni and calcineurin inhibitors. GBS should be considered in transplant patients presenting with weakness or paralysis in order to institute timely management.

Guillain-Barré syndrome after adoptive cell therapy with tumor-infiltrating lymphocytes

“…17 Recently, a systematic review analyzing 17 cases of GBS in renal transplant patients identified CMV as the most common trigger for this condition. 18 Generally, patients with CMV-triggered GBS were more likely to show predominantly sensory defects rather than axonal disease, as in our patient's case, revealing specificities of distribution of the target autoantigen related to CMV molecular mimicry. While our patient did not present with a primary CMV infection, he presented with a reactivation of CMV considered as a potential trigger for the neurological autoimmune reaction.…”

Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy after alemtuzumab therapy in kidney transplant recipients

“…This is higher than the incidence rate of these neuropathies in the general population and of kidney transplant recipients not treated with alemtuzumab. [5][6][7] Secondary autoimmunity after alemtuzumab appears to be mainly B cell driven. A mismatched reconstitution of T and B cells after alemtuzumab can lead to an expansion of B cells in the absence of appropriate T-cell regulation.…”

Guillain-Barre syndrome: a typical paraneoplastic syndrome in a kidney transplant recipient with allograft renal cell carcinoma: a case report and review of the literature

“…Most cases of GBS have been reported in bone marrow transplant recipients and are associated with graft versus host disease (GvHD) [19]. In recipients of solid organ transplants, mainly the heart, liver and kidney, GBS usually appears within 1 year after transplantation and is mainly related to CMV infection [2]. According to the patient's CMV and EBV serostatus in the present study, tissue invasion cannot be fully excluded; however, no obvious infectious cause of GBS was found in the performed laboratory tests.…”

“…Among symptoms experienced by renal transplant recipients, those connected with peripheral nerve damage are scarce. Guillain-Barré syndrome (GBS) is the most common acute ascending polyneuropathy in adults, affecting 0.5-2 per 100,000 people per year [2].…”

“…Unlike bone marrow transplant recipients, GBS in solid organ transplant patients is less often diagnosed. GBS after transplantation is predominantly linked with infections caused by cytomegalovirus (CMV) [3], Epstein-Barr virus (EBV) [4], Campylobacter jejuni and calcineurin inhibitors [2]. The paraneoplastic aetiology of peripheral polyneuropathy due to renal cell carcinoma [5,6] or its treatment [7] was previously reported but not in renal transplant recipients.…”