Neurological complications of solid organ transplantation

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.Keywords: organ transplantation; neurological manifestations; central nervous system; peripheral nervous system. RESUMO O transplante de órgãos sólidos é um importante avanço no tratamento de doenças crônicas 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 crônicas.Palavras-chave: transplante de órgãos; manifestações neurológicas; sistema nervoso central; sistema nervoso periférico.

Nursing Care for Kidney Transplant Patients: A Scoping Review

“…In the first 24 hours after kidney transplantation, nursing actions aim to prevent complications and prioritize the continuous evaluation of general health status with noninvasive monitoring of vital signs and evaluation of the nursing team of 1 hour/1 hour in the first 12 postoperative hours, which allows early and appropriate interventions for each type of worsening. This period of great potential for hemodynamic instability, cardiovascular and neurological complications, important metabolic alterations and the need for replacement of parenteral fluids in large volumes that require intensive care for the maintenance of life (5,23,43,(44)(45)(46)(47)(48)(49).…”

Post-transplant lymphoproliferative disorder myeloradiculopathy

“…CNS PTLD is a spectrum of diseases characterised by lymphoid or plasmocytic proliferation, and associated with solid organ, bone marrow or hematopoietic stem cell transplantation 1. It is the second most common malignancy in adult post-transplant patients; however, CNS involvement is rare, present in only 7%–15% of cases, and carries a poor prognosis for survival 2–6…”

“…Immunosuppression after transplantation is central to disease pathogenesis through impaired cellular immunity, a known risk factor for developing malignancies 7. Tacrolimus and cyclosporine may increase the risk of PTLD 1…”

“…Only a third of patients have infratentorial involvement. Spinal cord involvement is extremely rare with no reported cases of myeloradiculopathy, although there are reports of cauda equina syndrome and thoracic compressive myelopathy 1 4. Cavaliere et al reported spinal cord involvement in only 10% of CNS-PTLD cases 10.…”

Primary central nervous system post-transplant lymphoproliferative disorder mimicking toxoplasmosis

“…A diagnosis of monomorphic post-transplant lymphoproliferative disorder was made 1,2,3 . Mycophenolate was discontinued and the patient recovered.…”